*Purpose: To report the long term impact of check point inhibitors in patient and allograft survival among kidney transplant recipients.

*Methods: We report follow up of our 6 kidney transplant recipients with metastatic malignancies that were not responding to first-line treatment. These included two with squamous cell cancers (SCC), two with melanoma (MM), one with renal cell cancer (RCC), and one with adenocarcinoma (Adeno CA) of the lung.

*Results: 4 patients received anti-program death 1 (PD-1) antibody and 2 received a combination of anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and anti-PD-1 antibodies. 3 out of 6 patients developed acute kidney injury. 2 were biopsy-proven acute rejection with subsequent graft failure and one attributed to rejection but improved after holding the checkpoint inhibitor. 5 out of 6 patients had cancer progression and only one patient had remission with the use of checkpoint inhibitors.

*Conclusions: Checkpoint inhibitors are now frequently used for oncologic conditions. The impact of these therapies in solid organ transplant recipients was not assessed in clinical trials. Subsequent case reports highlight the major detrimental interactions of checkpoint inhibitors and the high risk of allograft rejection with their use. Yet, the cancer response to the treatment has not been assessed in long-term follow-up. Providers and patients need to be aware of the potential high risk of rejection and the poor remission rate with the use of checkpoint inhibitors.

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