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Kidney Week

Abstract: SA-PO1127

Contrary to Expectation: Preserved Renal Function After Using PD-1 Inhibitor Cemiplimab-rwlc in a Kidney Transplant Recipient

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Leghrouz, Muhannad, Mayo Clinic, Rochester, Minnesota, United States
  • Markovic, Svetomir N., Mayo Clinic, Rochester, Minnesota, United States
  • Kukla, Aleksandra, Mayo Clinic, Rochester, Minnesota, United States
Introduction

The use of the immune checkpoint inhibitors in transplant recipients with malignancy is associated with the risk of graft failure due to acute rejection. Here we present the first reported case of using Cemiplimab-rwlc (Libtayo), a recently approved programmed death receptor-1 (PD-1) blocking antibody for locally advanced and metastatic cutaneous squamous cell carcinoma (CSCC), in a kidney transplant recipient.

Case Description

48 yo male with a history of ESRD secondary to ADPKD, received 5/6 ABDR HLA mismatch living donor kidney transplant in May of 2016. He had class II DSAs (DR4 with MFI 1975). He received Thymoglobulin induction and maintenance immunosuppression with Tacrolimus, MMF and Prednisone. Protocol allograft biopsy at 2 years post transplant showed Banff borderline acute cellular rejection. At 2 years post transplant, he was diagnosed with metastatic CSCC of head & neck, HPV positive. Tacrolimus and MMF were discontinued and patient was switched to Sirolimus. Treatment included Mohs procedure, chemotherapy (paclitaxel/carboplatin/cetuximab) for 4 cycles and radiation for 5 months. He had good response to the cervical lymph nodes metastasis but had minimal sustained response to skull metastasis. Subsequently, he was switched from intratumoral 5FU to intratumoral IL2 and started on immunotherapy with Cemiplimab (Libtayo). Prednisone was discontinued. He underwent excision of scalp lesion and right cortical mastoid metastatectomy while on the full dose of Sirolimus, which he tolerated well. His kidney function remained stable throughout over 5 months follow up period (Figure-1).

Discussion

Literature reports a substantial risk of rejection in kidney transplant recipients who are treated with immunotherapy. However, as our case shows, PD-1 inhibitor Cemiplimab (Libtayo) can be used with preserving allograft function on a Sirolimus-based immunosuppression regimen. More data is needed in to guide clinicians and to appropriately counsel patients regarding the risks and benefits of immunotherapy medications.