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


ABSTRACT: 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.

SUBMITTER: Lipson EJ 

PROVIDER: S-EPMC7395855 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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

Lipson Evan J EJ   Naqvi Fizza F FF   Loss Manisha J MJ   Schollenberger Megan D MD   Pardoll Drew M DM   Moore Jack J   Brennan Daniel C DC  

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 20200412 8


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 pembrolizu  ...[more]

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