Safety and Efficacy of Immune Checkpoint Inhibitors in Patients on Dialysis: A Retrospective Case Series

Abstract

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Immune checkpoint inhibitor use in patients with end-stage kidney disease: an analysis of reported cases and literature review

“…With respect to severe (i.e. Grade 4) irAEs, notable reported events included one death in the context of encephalitis, one (nonfatal) episode of myocarditis and two (nonfatal) pneumonitis events [ 5 ]. The death associated with encephalitis was the only reported fatal event attributed to therapy.…”

Acute Kidney Transplant Rejection After Administration of Nivolumab in a Dialysis Patient With a Failed Graft

“… 6 In addition, a report of 19 dialysis patients who received ICI therapy between 2013 and 2019 showed that although 32% of the patients experienced diverse immune-related adverse effects, none of the 4 patients with previous failed kidney allografts included in the study had clinical evidence of rejection. 7 …”

“…5 A T cell–mediated rejection is an almost universal finding whenever a biopsy specimen is obtained, with approximately 50% of cases representing mixed acute T cell–mediated and antibody-mediated rejection whereas pure T cell–mediated rejection is diagnosed in the other 50%. 6 , 7 Of note, a considerable percentage of cases remained unspecified in most studies. 4 Our patient’s biopsy specimen revealed lesions highly suggestive of mixed acute rejection in accordance with the aforementioned pathologic patterns described in patients with functioning kidney grafts.…”

“…6 In addition, a report of 19 dialysis patients who received ICI therapy between 2013 and 2019 showed that although 32% of the patients experienced diverse irAEs, none of the 4 patients with prior failed kidney allografts included in the study demonstrated clinical evidence of rejection. 7 Here, we report a single case of kidney graft rejection of a long-term non-functioning graft 14 days after the first cycle of therapy with PD-1 inhibitor nivolumab. To our knowledge, this is the first case of acute transplant rejection in a previously transplanted anuric patient being on peritoneal dialysis for a long period of time.…”

Safety and Efficacy of Immune Checkpoint Inhibitors for Patients With Metastatic Urothelial Carcinoma and End-Stage Renal Disease: Experiences From Real-World Practice

“…Strohbehn et al presented a brief report of treatment response and side effects in 19 ESRD patients received ICI therapy. However, the study population were quite heterogeneous in cancer types (six genitourinary cancer, three melanoma, three merkel cell carcinoma, three head and neck cancer), ICI regimen (90% anti-PD-1/PD-L1, 5% anti-CTLA-4 and 5% combined anti-PD-1/CTLA-4), and dialysis modality (79% hemodialysis, 21% peritoneal dialysis), which limited to achieve a definite conclusion (32). Compared with previous reports, our study revealed more hematologic AEs, 36.4% of which were grade 3-4 neutropenia.…”