Abstract: SA-PO1250
Effect of Immunosuppression Modulation on Clinical Outcomes in Kidney Transplant Recipients Receiving Immune Checkpoint Inhibitors
Session Information
- Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Rungta, Manav, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Sampangirama, Neel Anil, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Mamlouk, Omar, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Abudayyeh, Ala, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Youssef, Nada, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Background
The use of Immune Checkpoint Inhibitors (ICIs) in solid organ transplant recipients remains a clinical challenge due to the risk of allograft rejection. This study evaluates the safety and oncologic outcomes of ICIs in a cohort of kidney transplant recipients.
Methods
We conducted a retrospective analysis of 22 patients. The median age was 58.5 years (range: 38–83), with a male predominance (n=18, 81.8%). Baseline renal function showed a median serum creatinine of 1.34 mg/dL (range: 0.84–4.94). Primary malignancies treated included melanoma (n=10), genitourinary (GU) cancers (n=6), squamous cell carcinoma (SCC) (n=4), and other malignancies (n=2). The median interval from transplant to ICI initiation was 5 years (range: 1–39 years).
Results
Regarding immunosuppression at the time of ICI initiation, 14 patients were maintained on tacrolimus, while 8 patients were either maintained on or switched to sirolimus. All patients remained on prednisone, and 5 continued mycophenolate mofetil (MMF).
Acute allograft rejection occurred in 5 patients (22.7%). Numerically, the rejection rate was lower in the sirolimus group (n=1/8; 12.5%) compared to the tacrolimus group (n=4/14; 28.6%). Rejection pathology included mixed cell-mediated and humoral rejection (n=3) and isolated cell-mediated rejection (n=2; Banff 2A, 2B, 3). Notably, 2 of
the patients who rejected were on dual therapy with MMF and tacrolimus. No other immune-related adverse events (irAEs) were observed in the cohort.
Conclusion
ICIs in kidney transplant recipients carry a significant risk of severe, high-grade allograft rejection (22.7%). Our data suggests a potential trend toward lower rejection rates in patients maintained on or switched to sirolimus-based regimens compared to tacrolimus. While the absence of extra-renal irAEs is encouraging, the risk of graft loss necessitates cautious patient selection and further investigation into the potentially protective role of mTOR inhibitor-based immunosuppression.