Prolonged Survival and Preserved Renal Graft Function in a Kidney Transplant Patient With Advanced Urothelial Carcinoma Using an Immune Checkpoint Inhibitor: A Case Report

Abstract

U pper tract urothelial carcinoma (UTUC) is a rare but aggressive malignancy with an incidence of 2 cases per 100 000 people. 1 Cisplatin-based chemotherapy is the standard treatment for advanced UTUC with a very poor prognosis. The median overall survival is 6-15 mo and the 5-y survival rate is <5%. 2 Pembrolizumab, an immune checkpoint inhibitor (ICI), has been introduced for treating advanced urothelial carcinoma (UC) in cisplatin-ineligible patients. 3 However, to our knowledge, there is no report concerning treating advanced UTUC in kidney transplant patients (KTPs). Managing advanced UTUC in KTPs is a challenging problem for nephrologists and oncologists. Reducing the dose of immunosuppressants may be required to lower the risk of oncogenesis. However, this may increase the risk of acute rejection and graft loss. Furthermore, cisplatin-based