Use of Ipilimumab and Pembrolizumab in Metastatic Melanoma in a Combined Heart and Kidney Transplant Recipient: A Case Report.

Use of Ipilimumab and Pembrolizumab in Metastatic Melanoma in a Combined Heart and Kidney Transplant Recipient: A Case Report.

Publication date: Feb 07, 2020

New therapeutic agents such as checkpoint inhibitors are promising strategies in the treatment of metastatic melanoma. Transplant recipients are generally at higher risk of malign diseases. Limited data are available for the use and safety of these agents in this population. We describe a patient who had a stable transplant function over years after a combined heart and kidney transplantation. Immunosuppressive medications included tacrolimus and azathioprine and were later switched to sirolimus and azathioprine. Metastatic melanoma was diagnosed; after detailed explanation of the potential risk, the patient was initially treated with the anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) antibody ipilimumab but experienced an acute kidney graft rejection and rapid progression. Rejection therapy with high-dose corticosteroids was successful, and kidney function was stabilized. Because of the urgent request of the patient for additional therapy, he received a PD-1 inhibitor. Acute kidney graft rejection resulted, with indication for acute dialysis. He developed severe candida pneumonia and died despite extensive antimicrobial therapy. Checkpoint inhibitors have become the standard in a broad entity of tumors. Organ transplant patients are at higher risk of developing malignant diseases. Limited data are available for the use of checkpoint inhibitors in this subgroup, and the use of checkpoint inhibitors is associated with a high risk of graft rejection.

, Soellradl, Kehrer, H., and Cejka, D. Use of Ipilimumab and Pembrolizumab in Metastatic Melanoma in a Combined Heart and Kidney Transplant Recipient: A Case Report. 25762. 2020 Transplant Proc.

Concepts Keywords
Antibody Tumors
Antigen Severe candida pneumonia
Antimicrobial Organ transplant
Azathioprine Dialysis
Corticosteroids Kidney transplantation
Cytotoxic T Lymphocyte Medicine
Dialysis Medical specialties
Graft Rejection Clinical medicine
Inhibitor Immunosuppressants
Ipilimumab Transplantation medicine
Kidney RTT
Kidney Transplantation Antineoplastic drugs
Lymphocyte Transplant rejection
Malignant Kidney transplantation
Melanoma Immunosuppressive drug
Metastatic Melanoma Organ transplantation
Pneumonia Azathioprine
Sirolimus Transplantation
Subgroup Dialysis
Tacrolimus

Semantics

Type Source Name
drug DRUGBANK Ipilimumab
drug DRUGBANK Pembrolizumab
disease MESH Melanoma
pathway KEGG Melanoma
drug DRUGBANK Tacrolimus
drug DRUGBANK Azathioprine
drug DRUGBANK Sirolimus
disease MESH pneumonia
disease MESH tumors

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