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Kidney Week

Abstract: SA-OR002

Safety of Immune Checkpoint Inhibitors for Cancer Treatment Among Kidney Transplant Patients: A Systematic Review

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology


  • Manohar, Sandhya, Mayo Clinic, Rochester, Minnesota, United States
  • Thongprayoon, Charat, Mayo Clinic, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Herrmann, Sandra, Mayo Clinic, Rochester, Minnesota, United States

The use of immune checkpoint inhibitors have significantly improved outcomes in multiple cancer types. Kidney Transplant (Ktx) recipients are excluded from trials due to the concern of allo-immunity and possible allograft rejection. Aim of this systematic review was to assess the safety of checkpoint inhibitors among KTx patients.


Literature search was conducted utilizing MEDLINE, EMBASE and Cochrane Database from inception through April 2019. We included studies that reported outcomes of kidney transplant recipients who received immune checkpoint inhibitors for cancer therapy. Outcomes of interest were allograft rejection and/or allograft failure, The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019126777).


27 articles with a total of 44 KTx patients treated with immune checkpoint inhibitors were identified. Of 44 KTx patients, 18 were reported to have acute rejection of renal allograft. Among those with acute allograft rejection following the treatment, 83% were males with mean age of 62 +/- 13 years. 8 (44%) patients received nivolumab, 3 (17%) received pembrolizumab, 2 (11%) received ipilimumab, 2 (11%) received ipilimumab followed by pembrolizumab, 2 (11%) received ipilimumab followed by nivolumab, and 1 (6%) received pembrolizumab followed by nivolumab. Cancer types were melanoma (66%), lung cancer (17%), and metastatic squamous cell carcinoma of skin (12%), respectively. 3 patients had a partial remission (17%), a patient achieved cancer response (6%) and 5 patients had stable disease (28%). Median time from immune checkpoint inhibitors to acute rejection diagnosis was 24 (IQR 10-60) days. Reported types of acute allograft rejection were cellular rejection (33%), mixed cellular and antibody mediated rejection (17%), and unspecified type (50%). 15 (83%) had allograft failure and 8 (44%) died.


The findings of our study raise awareness of the potential risk of acute allograft rejection/failure following immune checkpoint inhibitors for cancer treatment among KTx patients. Future large-scale clinical studies are required to appraise the pathogenesis and plan optimal therapy that helps sustain graft tolerance without discouraging clinical benefits of immune checkpoint inhibitors for cancer treatment.