Articles

Immune checkpoint inhibition in kidney transplant recipients

BJMO - 2021, issue BJMO IO Special, december 2021

T. Feys MSc, MBA, T. Van Meerhaeghe MD

Over the last years, immune checkpoint inhibition (ICI) emerged as an important therapeutic modality across a variety of cancer types. However, kidney and other solid organ transplant recipients (SOTR) have systematically been excluded from those trials, mainly due to concerns for organ rejection and the use of immunosuppressive therapy in these patients. As a result, little is known about the safety and efficacy of ICI in this setting. Given the increased cancer risk in kidney transplant recipients, with an overrepresentation of certain cancer types for which ICI has become the new standard of care, this represents an important data gap. Based on the scanty data available in the literature, one can conclude that the tumoral response rate to ICI among SOTR suffering from cancer is in line with what is seen in the general cancer population. However, this comes at the cost of an increased risk of allograft rejection and graft loss. This article will briefly discuss the increased cancer risk among kidney transplant recipients after which the available data on the use of ICIs in kidney transplant recipients (KTR) will be summarized, with a particular focus on treatment efficacy and risk factors associated with allograft rejection.

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