Outcomes of Solid Organ Transplant Recipients With Advanced Cancers Receiving Immune Checkpoint Inhibitors: A Systematic Review and Individual Participant Data Meta-Analysis
Pooling 343 solid organ transplant recipients (most kidney) treated with immune checkpoint inhibitors for advanced cancer, this analysis found high rates of allograft rejection and cancer death, but lower rejection risk when mTOR inhibitors plus steroids were maintained.
Study design
A systematic review and individual participant data meta-analysis of 128 studies involving 343 solid organ transplant recipients (70.9% kidney) treated with immune checkpoint inhibitors for advanced-stage cancer, searched through June 2024.
Key findings
Within 3 years of checkpoint-inhibitor initiation, 52.8% died of cancer. Acute rejection occurred in 36.2% at 1 year and 18.4% experienced graft loss at 1 year. Objective tumor response at 1 year was 31.6%, highest in cutaneous squamous cell carcinoma (61.0%).
Clinical implications
Maintenance with mTOR inhibitors plus steroids during checkpoint-inhibitor therapy was associated with lower rejection risk (HR 0.30, 95% CI 0.14-0.63) than other regimens, while recipients with melanoma and other solid cancers had higher cancer-related death and rejection than those with cutaneous squamous cell carcinoma - underscoring the need to individualize the rejection-versus-tumor-control trade-off.
Category
Transplant
Source
JAMA Oncology
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