Abstract
BackgroundThe management of malignancy post kidney transplantation includes reduction in immunosuppression and referral to an oncologist management of their malignancy. Recent advances in oncology have resulted in the approval of several classes of drugs with immune-modulatory activity. However, activation of the immune system against malignant cells may precipitate allograft rejection in solid organ transplant recipients.Case presentationHerein we present a case of acute kidney allograft rejection in a 50 year old man following administration of the novel immune-modulatory agent nivolumab for the treatment of metastatic squamous cell carcinoma.ConclusionThe management of malignancy in solid organ transplant recipients requires a heightened awareness of the potential for allograft rejection in this new era of cancer therapeutics.
Highlights
The management of malignancy post kidney transplantation includes reduction in immunosuppression and referral to an oncologist management of their malignancy
Reduction in immunosuppression in the kidney transplant recipient with malignancy may result in acute allograft rejection, which may result in reduced renal function and inability to administer appropriate chemotherapy; thereby worsening the patient’s prognosis
We report the case of a 50 year-old man with end-stage renal disease (ESRD) secondary to polycystic kidney disease (PKD) who underwent a living unrelated donor renal transplant (LURT) followed by immune-mediated graft loss in November 2015 after treatment with nivolumab for metastatic squamous cell carcinoma (SCC)
Summary
The approach to patients who develop malignancy post kidney transplantation has traditionally focused on reduction of overall immunosuppression and the administration of cytotoxic chemotherapy agents under the management of a medical oncologist. We report the case of a 50 year-old man with end-stage renal disease (ESRD) secondary to polycystic kidney disease (PKD) who underwent a living unrelated donor renal transplant (LURT) followed by immune-mediated graft loss in November 2015 after treatment with nivolumab for metastatic squamous cell carcinoma (SCC). He achieved a durable anti-cancer benefit from nivolumab, with a partial response that is ongoing for more than 18 months. Histologic evaluation revealed hemorrhagic infarction with features of acute and chronic vascular rejection (Fig. 1) He continues treatment with nivolumab and most recent imaging 18 months after treatment initiation shows stable tumor regression. He has been maintained on hemodialysis, but has been able to travel and return to an active lifestyle
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