Which one of these immune check point inhibitors leads to loss of transplanted kidney?
The correct answer is nivolumab or PD-1 inhibitors. Several cases of kidney injury have
now been reported when the immune check point inhibitor use in kidney
transplant patients. While Lipson et al had initially reported successful administration
of ipilimumab to two kidney transplantation patients
with metastatic melanoma without any rejection, they recently reported a case
of tumor regression but allograft rejection after administration of pembrolizumab. In addition, three cases of rejection were
reported with use of nivolumab in renal
transplant patients with melanoma.
https://www.ncbi.nlm.nih.gov/pubmed/26951628
https://www.ncbi.nlm.nih.gov/pubmed/26988410
Based on the 6 cases, it appears that PD-1 inhibitors are more prone to causing rejection in the transplanted kidney compared to CTLA-4 antagonists , especially when the patients have received anti CTLA-4 agents prior to PD-1 inhibitor treatment. Graft tolerance might be minimized and hence rejection ensues.
https://www.ncbi.nlm.nih.gov/pubmed/26988410
Based on the 6 cases, it appears that PD-1 inhibitors are more prone to causing rejection in the transplanted kidney compared to CTLA-4 antagonists , especially when the patients have received anti CTLA-4 agents prior to PD-1 inhibitor treatment. Graft tolerance might be minimized and hence rejection ensues.
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