Session Name: Non-PTLD/Malignancies
Session Date & Time: None. Available on demand.
*Purpose: Immune checkpoint inhibitors (ICI) are an emerging treatment for numerous advanced diseases, but their safety and efficacy in immunosuppressed transplant patients is not known. This study undertakes a scoping review of research on ICI use in solid organ transplant (SOT) recipients to determine: 1) What is the effect of ICI on SOT recipients?; 2) What factors influence the effect of ICI on SOT recipients?
*Methods: Data Sources: Searches of PubMed, Scopus and MEDLINE were performed with language restrictions on September 1, 2020. Study Selection: Any studies that reported the use of ICI in patients with a history of SOT were included irrespective of study design. Data Extraction: Three reviewers independently screened citations and performed data abstractions. A variety of variables were extracted from each publication. Data Synthesis: Of the total 549 screened articles, 50 articles met inclusion criteria with a sum of 101 cases of ICI use in patients with a history of SOT.
*Results: Graft rejection occurred in 42% (n=42) of the cases. Kidneys were the most commonly rejected organ (n=28) with PD-1 inhibitors being the often-implicated etiology (n=32). Nearly 100% of the cases of graft rejection transpired within 2 months of ICI initiation. Patients on steroid monotherapy had higher rejection rates (72%, n=13) versus those on a steroid plus one or more immunosuppressive agents. In cases where graft preservation was pursued, salvage occurred 33% of the time (n=9). Regardless of graft outcomes, patient outcomes were overall poor due to advanced disease. In cases where patient outcome was reported, 71% (n=39) died directly from disease progression.
*Conclusions: ICI offer a promising therapeutic alternative to traditional chemoradiation for patients with advanced malignancies. However, their use in patients with a history of SOT poses a significant risk to the transplanted organ and cancer outcomes are worse in patients with SOT. Future studies are needed to delineate the risk and benefit more clearly.
To cite this abstract in AMA style:Anderson AG, Eubank M, Murray K. Use of Immune Checkpoint Inhibitors in Solid Organ Transplant Recipients: A Scoping Review [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/use-of-immune-checkpoint-inhibitors-in-solid-organ-transplant-recipients-a-scoping-review/. Accessed June 13, 2021.
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