Acute renal transplant rejection following nivolumab therapy for metastatic melanoma

Area of Science:

• Oncology
• Immunology
• Transplantation

Background:

• Immune checkpoint inhibitors (ICIs) are revolutionary cancer therapies.
• ICIs have shown efficacy in metastatic melanoma.
• Data on ICI toxicity in allograft transplant recipients is scarce.

Observation:

• A 71-year-old woman with metastatic melanoma post-renal transplant received nivolumab.
• She experienced acute renal transplant rejection 15 days after the first ICI dose.
• The patient achieved a complete oncological response but requires ongoing hemodialysis.

Findings:

• This case illustrates a significant risk of acute renal transplant rejection with ICI use.
• Effective cancer control was achieved despite the adverse event.
• The balance between oncological outcomes and transplant integrity is crucial.

Implications:

• Clinicians and patients must weigh the benefits of ICIs against the risk of graft rejection.
• Informed consent regarding potential lifelong dialysis is essential for transplant recipients considering ICIs.
• Further research is needed to understand and mitigate ICI-related toxicities in this population.