Kidney retransplantation after anti-programmed cell death-1 (PD-1)-related allograft rejection.

Kidney retransplantation after anti-programmed cell death-1 (PD-1)-related allograft rejection.

Publication date: Aug 01, 2020

In this report, we describe the first kidney retransplantation performed after anti-programmed cell death-1 (PD-1)-related allograft rejection. In 2014, we administered pembrolizumab (anti-PD-1) for ~9 months to a 57-year-old kidney transplant recipient with metastatic cutaneous squamous cell carcinoma (CSCC). The patient experienced both a complete antitumor response and T cell-mediated allograft rejection requiring reinitiation of hemodialysis. Four-and-a-half years after initiating pembrolizumab, the patient remained without evidence of CSCC relapse and received a kidney transplant from a living-unrelated donor. Ten-and-a-half months after kidney retransplantation, the allograft is functioning well and the patient’s CSCC remains in remission. This case illustrates the potential for PD-1 blockade to bring about durable immune-mediated tumor control in chronically immunosuppressed patients, and begins to address the feasibility of kidney retransplantation in patients who have previously received immune checkpoint inhibitor therapy for cancer. Results from this and future cases may help elucidate mechanisms of antitumor immunity and allograft tolerance, and inform updates to transplant decision models. Our report also underscores the need for clinical trials testing novel immunotherapy combinations in solid organ transplant recipients designed to uncouple antitumor and anti-allograft immunity.

Concepts Keywords
Allograft Immunosuppression
Blockade Organ transplant
Cancer Hemodialysis
Clinical Trials Immunotherapy
Hemodialysis Kidney transplant
Immune Checkpoint Inhibitor Medical specialties
Immunity Clinical medicine
Immunosuppressed Transplantation medicine
Immunotherapy Organ transplantation
Kidney Immune system
Kidney Transplant Immunology
Metastatic Clusters of differentiation
Organ Transplant rejection
Relapse Allotransplantation
Remission Kidney transplantation
Squamous Carcinoma


Type Source Name
pathway REACTOME Programmed Cell Death
pathway KEGG Allograft rejection
drug DRUGBANK Pembrolizumab
disease MESH squamous cell carcinoma
disease MESH relapse
drug DRUGBANK Pentaerythritol tetranitrate
disease MESH tumor

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