Systematic Review of the Safety of Immune Checkpoint Inhibitors Among Kidney Transplant Patients

Sandhya Manohar, Charat Thongprayoon, Wisit Cheungpasitporn, Svetomir N. Markovic, Sandra M. Herrmann

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Introduction: Kidney transplant (Ktx) recipients are excluded from clinical trials of immune checkpoint inhibitors. The aim of this systematic review was to assess the safety of immune checkpoint inhibitors among Ktx patients. Methods: A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through April 2019. We included studies that reported outcomes of Ktx recipients who received immune checkpoint inhibitors for cancer treatment. Outcomes of interest were allograft rejection and/or allograft failure. Results: Twenty-seven articles with a total of 44 Ktx patients treated with immune checkpoint inhibitor were identified. Of 44 Ktx patients, 18 were reported to have acute rejection. Median time from immune checkpoint inhibitors to acute rejection diagnosis was 24 (interquartile range, 10–60) days. Reported types of acute allograft rejection were cellular rejection (33%), mixed cellular and antibody-mediated rejection (17%), and unspecified type (50%). Fifteen (83%) had allograft failure and 8 (44%) died. Three patients had a partial remission (17%), 1 patient achieved cancer response (6%), and 5 patients had stable disease (28%). Conclusion: The findings of our study raise awareness of the increased risk for acute allograft rejection/failure following immune checkpoint inhibitors for cancer treatment among Ktx patients, in particular with programmed cell death 1 (PD-1) inhibitors. Future large-scale clinical studies are required to appraise the pathogenesis and plan optimal balanced therapy that helps sustain graft tolerance.

Original languageEnglish (US)
Pages (from-to)149-158
Number of pages10
JournalKidney International Reports
Issue number2
StatePublished - Feb 2020


  • PD-1 inhibitor
  • allograft rejection
  • immune checkpoint inhibitors
  • immunosuppresants
  • kidney transplant
  • systematic review

ASJC Scopus subject areas

  • Ophthalmology
  • Nephrology


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