Tan Brandon, Baxter Mark, Casasola Richard
Tayside Cancer Centre, Ninewells Hospital, Dundee, Dundee, UK
Tayside Cancer Centre, Ninewells Hospital, Dundee, Dundee, UK.
BMJ Case Rep. 2021 Feb 8;14(2):e238037. doi: 10.1136/bcr-2020-238037.
Cancers can develop the ability to evade immune recognition and destruction. Immune checkpoint inhibitors (ICIs) are drugs targeting these immune evasion mechanisms. ICIs have significantly improved outcomes in several cancers including metastatic melanoma. However, data on toxicities associated with allograft transplant recipients receiving ICI is limited. We describe a case of a 71-year-old woman who was diagnosed with metastatic melanoma 13 years after renal transplantation. She was commenced on the ICI nivolumab. She developed acute renal transplant rejection 15 days after administration of the first dose. She continues on haemodialysis but has demonstrated complete oncological response. This case demonstrates the risk of acute renal transplant rejection versus improved oncological outcomes. Patients and clinicians must consider this balance when initiating ICI therapy in allograft transplant recipients. Patients should be fully consented of the potential consequences of acute renal transplant rejection including lifelong dialysis.
癌症能够发展出逃避免疫识别和破坏的能力。免疫检查点抑制剂（ICIs）是针对这些免疫逃逸机制的药物。ICIs在包括转移性黑色素瘤在内的几种癌症中显著改善了治疗结果。然而，关于接受ICI的同种异体移植受者相关毒性的数据有限。我们描述了一例71岁女性病例，她在肾移植13年后被诊断为转移性黑色素瘤。她开始使用ICI纳武单抗治疗。在给予首剂药物15天后，她发生了急性肾移植排斥反应。她继续接受血液透析，但已显示出完全的肿瘤学缓解。该病例证明了急性肾移植排斥反应的风险与改善的肿瘤学结果之间的权衡。在同种异体移植受者中启动ICI治疗时，患者和临床医生必须考虑这种平衡。应让患者充分了解急性肾移植排斥反应的潜在后果，包括终身透析。
