BACKGROUND: This meta-analysis has been conducted to determine the risk of 
elevated transaminases associated with immune checkpoint inhibitors use in 
patients with cancer.
METHODS: Studies eligible for our analysis included randomized Phase II and III 
trials of patients with cancer on ipilimumab, nivolumab, pembrolizumab, 
tremelimumab and pidilizumab, which describe events of elevated transaminases 
[alanine aminotransferase (ALT) and aspartate aminotransferase (AST)].
RESULTS: Initial database search revealed 210 relevant citations. After 
excluding noneligible studies, 10 trials were considered eligible for the 
quantitative synthesis. The RR of all-grade elevated ALT and AST was 2.36 (95% 
CI 1.20-4.66; p = 0.01) and 1.53 (95% CI 0.73-3.22; p = 0.26), respectively, 
whereas for high-grade elevated ALT and AST, it was 11.27 (95% CI 5.38-23.63; p 
< 0.0001) and 4.9 (95% CI 2.97-8.09; p < 0.0001), respectively.
CONCLUSIONS: Our study has shown that the use of immune checkpoint inhibitors 
has a causal relationship to an increased risk of high-grade elevated ALT and 
AST. Clinicians using these agents should be attentive of this risk.