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Abstract: TH-OR34

Immune Checkpoint Inhibitor Use in Kidney Transplant Recipients: A Multicenter Study

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Murakami, Naoka, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Riella, Leonardo V., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Wanchoo, Rimda, Northwell Health, Great Neck, New York, United States
  • Nair, Vinay, Northwell Health, Great Neck, New York, United States
  • Jhaveri, Kenar D., Northwell Health, Great Neck, New York, United States

Group or Team Name

  • Immune Checkpoint Inhibitor in Solid Organ Transplant Consortium
Background

Immune checkpoint inhibitors (ICIs) significantly improved the survival in many cancers, but the data on survival benefit in KTx recipients are lacking. ICIs are reported to be associated with higher acute rejection rate in KTx recipients, but the risk factors of ICI-associated rejection are not fully understood.

Methods

We conducted a multicenter observational study to investigate the clinical characteristics of ICI-associated rejection and the survival outcomes of KTx recipients treated with ICI. 66 KTx patients with a functioning allograft at the time of ICI initiation were collected from 18 institutions. In addition, historical control groups of KTx recipients with advanced stage melanoma (AJCC stage III-IV, n=17) and cutaneous squamous cell carcinoma (cSCC, AJCC stage III (unresectable)-IV), n=23), who could be considered as potential ICI candidates, were collected to compare the overall survival (OS).

Results

In ICI cohort, median age was 64, male dominant (83%) and transplant to ICI initiation was median 11 years. cSCC was the most frequent malignancy (n=22), followed by melanoma (n=21). 28 patients (42.4%) experienced rejection, of which 18 (64.2%) lost allograft and returned to dialysis. Median time from ICI initiation to rejection was 26 days. In biopsy-proven rejection (n=13), both mixed acute cell and antibody-mediated rejection (n=7, 53%) and acute cell-medicated rejection (n=6, 47%) were seen. By Chi square test, mTOR inhibitor use (*p=0.012) and the use of higher number of immunosuppression drugs (*p=0.049) were associated with lower risk of rejection. For both melanoma and cSCC cohort, ICI groups experienced higher rejection rate (57% and 40%, for melanoma and cSCC, respectively), compared to non-ICI control groups (12% and 4.3%), suggesting the higher rejection rate in ICI groups was not solely explained by reduction in immunosuppression. OS didn’t show statistical difference in melanoma cohort (log rank test p=0.22), but OS was significantly longer in cSCC cohort (log rank test *p=0.015), when compared ICI vs non-ICI control groups.

Conclusion

Our multi-center study provides a novel data on the survival benefit and the risk factors of rejection in KTx recipients with ICI use compared to non-ICI control groups.

Funding

  • NIDDK Support