Legris Tristan, Sallée Marion, Charmetant Xavier, Thaunat Olivier, Matignon Marie, Joher Nizar, Pernin Vincent, Sicard Antoine, Kaminski Hannah, Couzi Lionel, Moal Valérie
Department of Nephrology and Kidney Transplantation, APHM, Conception University Hospital, Marseille, France.
Department of Transplantation, Nephrology, and Clinical Immunology, Edouard Herriot Hospital, HCL, Lyon, France.
Transplant Direct. 2025 Aug 1;11(9):e1851. doi: 10.1097/TXD.0000000000001851. eCollection 2025 Sep.
Kidney transplant recipients (KTRs) are at elevated risk of malignancy. Data on the safety and efficacy of immune checkpoint inhibitors (ICIs) in this population remain limited. We aimed to reassess the benefit-risk profile of ICI therapy in KTRs using a multicenter cohort, in the recent era.
We conducted a retrospective cohort study of all KTRs treated with ICIs for advanced or metastatic cancer, across 6 transplant centers. We evaluated cancer response, acute rejection (AR) incidence, graft survival, and patient survival.
From 2015 to 2024, 34 KTRs were analyzed. The most common cancers were cutaneous (56%) and non-small cell lung cancer (32%). Pembrolizumab was the most used ICI (53%). The objective response rate was 38%, with a median progression-free survival of 5.5 mo and an overall survival of 10.7 mo. Biopsy-proven AR occurred in 26.5% of patients, at a median time of 52 d after ICI start. All rejection episodes involved T cells, and one-third showed additional humoral features. No clinical predictors of AR were identified. Among all patients, 29% had a favorable outcome (tumor response without ICI-induced graft loss), 12% experienced a tumor response with graft loss, 59% had progression disease without graft loss, and 3% experienced the worst outcome (progression disease with graft loss).
Our study suggests that ICI therapy is a viable option for KTRs with poor-prognosis cancers, demonstrating a 38% tumor response rate and a lower incidence of graft loss (15%) compared with previously reported rates. Prospective studies are needed to optimize the use of ICI in KTRs.
肾移植受者（KTRs）患恶性肿瘤的风险较高。关于免疫检查点抑制剂（ICIs）在该人群中的安全性和有效性的数据仍然有限。我们旨在利用多中心队列研究，在最近的时期重新评估ICIs治疗KTRs的获益风险情况。
我们对6个移植中心所有接受ICIs治疗晚期或转移性癌症的KTRs进行了一项回顾性队列研究。我们评估了癌症反应、急性排斥反应（AR）发生率、移植物存活情况和患者存活情况。
2015年至2024年，分析了34例KTRs。最常见的癌症是皮肤癌（56%）和非小细胞肺癌（32%）。帕博利珠单抗是最常用的ICIs（53%）。客观缓解率为38%，无进展生存期的中位数为5.5个月，总生存期为10.7个月。经活检证实的AR发生在26.5%的患者中，发生时间中位数为开始使用ICIs后52天。所有排斥反应均涉及T细胞，三分之一表现出额外的体液特征。未发现AR的临床预测因素。在所有患者中，29%有良好结局（肿瘤反应且无ICIs诱导的移植物丢失），12%出现肿瘤反应并伴有移植物丢失，59%有疾病进展但无移植物丢失，3%出现最差结局（疾病进展并伴有移植物丢失）。
我们的研究表明，ICIs治疗对于预后不良的KTRs癌症患者是一种可行的选择，显示出38%的肿瘤反应率，与先前报道的发生率相比，移植物丢失发生率较低（15%）。需要进行前瞻性研究以优化ICIs在KTRs中的使用。
