Although the indications for immune checkpoint inhibitors continue to grow, organ transplant recipients with advanced malignancies have been largely excluded from clinical trials testing the safety and efficacy of these therapies given their need for chronic immunosuppression and the risk of allograft rejection. With the rapid growth of transplant medicine and the increased risk of malignancy associated with chronic immunosuppression, it is critical that we systematically analyze the available data describing immune checkpoint blockade in the organ transplant population. Herein we provide a current and comprehensive review of cases in which immune checkpoint blockade was used on organ transplant recipients. Furthermore, we discuss the differences in efficacy and risk of allograft rejection between CTLA-4 and PD-1 inhibitors and make recommendations based on the limited available clinical data. We also discuss the future of immune checkpoint blockade in this subpopulation and explore the emerging data of promising combination therapies with mTOR, BRAF/MEK, and BTK/ITK inhibitors. Further clinical experience and larger clinical trials involving immune checkpoint inhibitors, whether as monotherapies or combinatorial therapies, will help develop regimens that optimize anti-tumor response and minimize the risk of allograft rejection in organ transplant patients.

尽管免疫检查点抑制剂的适应症持续增长，但由于其需要长期免疫抑制和同种异体移植排斥的风险，因此患有恶性肿瘤晚期的器官移植受者已被广泛排除在测试这些疗法的安全性和有效性的临床试验中。随着移植医学的迅速发展以及与慢性免疫抑制相关的恶性风险的增加，至关重要的是，我们有系统地分析可用于描述器官移植人群中免疫检查点阻滞作用的可用数据。在本文中，我们提供了对器官移植接受者使用免疫检查点封锁的案例的最新，全面的综述。此外，我们讨论了CTLA-4和PD-1抑制剂在同种异体移植排斥反应的功效和风险方面的差异，并根据有限的可用临床数据提出了建议。我们还讨论了该亚群中免疫检查点封锁的未来，并探讨了有前景的与mTOR，BRAF / MEK和BTK / ITK抑制剂联合治疗的数据。涉及免疫检查点抑制剂的进一步临床经验和更大规模的临床试验，无论是作为单一疗法还是联合疗法，都将有助于开发可优化抗肿瘤反应并最大程度降低器官移植患者异体移植排斥风险的方案。BRAF / MEK和BTK / ITK抑制剂。涉及免疫检查点抑制剂的进一步临床经验和更大规模的临床试验，无论是作为单一疗法还是联合疗法，都将有助于开发可优化抗肿瘤反应并最大程度降低器官移植患者异体移植排斥风险的方案。BRAF / MEK和BTK / ITK抑制剂。涉及免疫检查点抑制剂的进一步临床经验和更大规模的临床试验，无论是作为单一疗法还是联合疗法，都将有助于开发可优化抗肿瘤反应并最大程度降低器官移植患者异体移植排斥风险的方案。