@ISNEducation Nuances in Nephrology Webinar: Immune Checkpoint Inhibitors Nephrotoxicity in Native and Kidney Transplantation

Solid organ transplant recipients are at increased risk of cancer due to long-term immunosuppression. Immune-Checkpoint Inhibitors (ICI) showed clinical benefits but increased risk of transplant rejection. The main indication for ICI in transplant recipients was malignant melanoma. In general the time to onset between first ICI administration and rejection is within one month. Kidney transplant rejection was associated with nivolumab , pembrolizumab and ipilimumab; overall, anti-PD-1 and anti-PD-L1 are more involved than anti-CTLA-4 drugs. When performed, all biopsies reported acute cellular rejections, but only a few showed concomitant antibody-mediated lesions. Management mainly consisted in intravenous corticosteroid boluses and ICI cessation. 

Rejections are T-cell mediated with low participation of humoral response.