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Case report
Acute renal transplant rejection following nivolumab therapy for metastatic melanoma
  1. Brandon Tan1,
  2. Mark Baxter1,2 and
  3. Richard Casasola1
  1. 1Tayside Cancer Centre, Ninewells Hospital, Dundee, Dundee, UK
  2. 2Division of Molecular and Clinical Medicine, Ninewells Hospital School of Medicine, University of Dundee, Dundee, UK
  1. Correspondence to Dr Brandon Tan; brandonszemann.tan{at}nhs.scot

Abstract

Cancers can develop the ability to evade immune recognition and destruction. Immune checkpoint inhibitors (ICIs) are drugs targeting these immune evasion mechanisms. ICIs have significantly improved outcomes in several cancers including metastatic melanoma. However, data on toxicities associated with allograft transplant recipients receiving ICI is limited. We describe a case of a 71-year-old woman who was diagnosed with metastatic melanoma 13 years after renal transplantation. She was commenced on the ICI nivolumab. She developed acute renal transplant rejection 15 days after administration of the first dose. She continues on haemodialysis but has demonstrated complete oncological response. This case demonstrates the risk of acute renal transplant rejection versus improved oncological outcomes. Patients and clinicians must consider this balance when initiating ICI therapy in allograft transplant recipients. Patients should be fully consented of the potential consequences of acute renal transplant rejection including lifelong dialysis.

  • unwanted effects / adverse reactions
  • skin cancer
  • cancer intervention
  • malignant disease and immunosuppression

https://doi.org/10.1136/bcr-2020-238037

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    Footnotes

    • Contributors Dr Brandon Tan collected data on the patient, wrote this case report and obtained consent from the patient. Dr Mark Baxter supervised the writing of this case report and critically reviewed the accuracy of information presented in this case report. Dr Richard Casasola provided advice and support for the writing of this case report and was the Oncologist responsible for the patient’s care. All authors reviewed and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.