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Published on: August 12, 2017
Immune Checkpoint Inhibitors in Transplantation-A Case Series and Comprehensive Review of Current Knowledge
Julie Delyon1, Julien Zuber2, Richard Dorent3
1Department of Dermatology, AP-HP Hôpital Saint Louis, Université de Paris, INSERM U976, Team 1, HIPI, Paris, France.
Abstract:
Cancer is a leading cause of morbidity and deaths in solid organ transplant recipients. In immunocompetent patients, cancer prognosis has been dramatically improved with the development of immune checkpoint inhibitors (ICI), as programmed cell death protein 1/programmed death-ligand 1 and cytotoxic T lymphocyte-associated antigen 4 inhibitors, that increase antitumor immune responses. ICI has been developed outside of the scope of transplantation because of the theoretical risk of graft rejection, which has later been confirmed by the publication of several cases and small series. The use of ICI became unavoidable for treating advanced cancers including in organ transplant patients, but their management in this setting remains highly challenging, as to date no strategy to adapt the immunosuppression and to prevent graft rejection has been defined. In this article, we report a monocentric series of 5 solid organ transplant recipients treated with ICI and provide a comprehensive review of current knowledge of ICI management in the setting of solid organ transplantation. Strategies warranted to increase knowledge through collecting more exhaustive data are also discussed.
Insights
Immune checkpoint inhibitors (ICIs) improve cancer outcomes but risk graft rejection in transplant patients. Managing advanced cancers in organ transplant recipients with ICIs remains challenging due to undefined immunosuppression strategies.
Area of Science:
- Oncology
- Transplant Immunology
- Immunotherapy
Background:
- Cancer is a major cause of death in solid organ transplant recipients.
- Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment in immunocompetent patients.
- ICI use in transplant patients is limited by the risk of graft rejection.
Purpose of the Study:
- To review current knowledge on managing ICIs in solid organ transplant recipients.
- To report a case series of transplant patients treated with ICIs.
- To discuss strategies for adapting immunosuppression and preventing graft rejection.
Main Methods:
- Monocentric case series of 5 solid organ transplant recipients treated with ICIs.
- Comprehensive literature review of ICI management in transplantation.
Main Results:
- ICI use in transplant patients is associated with a risk of graft rejection.
- Management strategies for ICIs in this population are not yet established.
- The study highlights the challenges in balancing cancer treatment and graft survival.
Conclusions:
- ICI treatment for advanced cancers in organ transplant recipients is increasingly necessary but complex.
- Further research and data collection are crucial for defining optimal management strategies.
- Developing protocols to adapt immunosuppression is essential to prevent graft rejection.
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