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Abstract: FR-PO285

Allograft Rejection Following Immune Checkpoint Inhibition After Renal Transplantation: An In-Depth Analysis of PD-1, PDL-1, and CTLA-4 Checkpoint Inhibitors

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • Sardar, Sundus, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Akkari, Abdel-Rauof M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Gul Yousaf Khan, Mohammad, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Trivedi, Naman, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Ghahramani, Nasrollah, Penn State College of Medicine, Hershey, Pennsylvania, United States

Immune checkpoint inhibitors (ICIs) have emerged as one of the most pivotal therapeutic agents in tumor immunotherapy, and now used in solid-organ transplant recipients as salvage therapy post-tumor recurrence or for management of secondary tumors. However, ICI-associated allograft rejection has surfaced as a particular concern in solid-organ transplant recipients.


We performed a retrospective multi-center cohort study using TriNetX, a global federated health research network providing access to electronic medical records across large healthcare organizations (HCOs) grouped into a network called Global Collaborative Network of 105 HCOs from 14 countries. We identified 164,034 post-renal transplant recipients without ICI use and 247 patients receiving ICI after transplant until May 11 2023 from 37 HCOs. Post-kidney transplant recipients in propensity-matched groups receiving either ICI or non-ICI regimen (n=247 each) were assessed for allograft rejection within first year of ICI exposure as compared to first-year allograft rejection in non-ICI group, with risk analysis and Kaplan-Meier survival analysis as relevant, with further analysis of renal allograft rejection in propensity-matched cohort comparisons with PD-1, PDL-1 and CTLA-4 inhibition.


Kidney allograft rejection within 1 year occurred in 14.9% of patients in the non-ICI cohort as compared to 11.33% in the ICI exposure group (RR=1.32; 95%CI 0.83-2.09). In renal transplant recipients on PD-1 versus CTLA-4 checkpoint inhibition, allograft rejection was confirmed in 30.3% of patients in each cohort (RR=1; 95%CI 0.48-2.08). Allograft rejection noted in 71% patients in CTLA-4 vs. PDL-1 cohorts(RR=1; 95%CI 0.63-1.59), and 50% of patients in PD-1 vs. PDL-1 cohort (RR=1; 95%CI 0.54-1.86). Our study demonstrates there was no significant difference in renal allograft rejection between ICI and non-ICI cohort.


After propensity matching, ICI exposure post-renal transplant was not associated with acute allograft rejection within one year of ICI exposure. Our analysis of allograft rejection with one-year exposure of either of three ICI classes did not reveal superior (or inferior) association as compared to first-year allograft rejection post-renal transplant in non-ICI cohort.