In this report, we describe the first kidney retransplantation performed after anti–programmed cell death‐1 (PD‐1)–related allograft rejection. In 2014, we administered pembrolizumab (anti–PD‐1) for ~9 months to a 57‐year‐old kidney transplant recipient with metastatic cutaneous squamous cell carcinoma (CSCC). The patient experienced both a complete antitumor response and T cell–mediated allograft rejection requiring reinitiation of hemodialysis. Four‐and‐a‐half years after initiating pembrolizumab, the patient remained without evidence of CSCC relapse and received a kidney transplant from a living‐unrelated donor. Ten‐and‐a‐half months after kidney retransplantation, the allograft is functioning well and the patient's CSCC remains in remission. This case illustrates the potential for PD‐1 blockade to bring about durable immune‐mediated tumor control in chronically immunosuppressed patients, and begins to address the feasibility of kidney retransplantation in patients who have previously received immune checkpoint inhibitor therapy for cancer. Results from this and future cases may help elucidate mechanisms of antitumor immunity and allograft tolerance, and inform updates to transplant decision models. Our report also underscores the need for clinical trials testing novel immunotherapy combinations in solid organ transplant recipients designed to uncouple antitumor and anti‐allograft immunity.

中文翻译：

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抗程序性细胞死亡 1 (PD-1) 相关同种异体移植排斥反应后的肾脏再移植。

在本报告中，我们描述了在抗程序性细胞死亡-1 (PD-1) 相关同种异体移植排斥反应后进行的首次肾脏再移植。2014 年，我们对一名患有转移性皮肤鳞状细胞癌 (CSCC) 的 57 岁肾移植受者给予派姆单抗（抗 PD-1）约 9 个月。患者经历了完全的抗肿瘤反应和需要重新开始血液透析的 T 细胞介导的同种异体移植物排斥反应。在开始使用帕博利珠单抗治疗四年半后，该患者仍然没有 CSCC 复发的证据，并接受了一位活体无关供体的肾移植。肾脏再移植后十个半月，同种异体移植物功能良好，患者的 CSCC 仍处于缓解期。该案例说明了 PD-1 阻断剂在长期免疫抑制患者中实现持久的免疫介导肿瘤控制的潜力，并开始探讨在先前接受过免疫检查点抑制剂治疗的癌症患者中进行肾脏再移植的可行性。这个案例和未来案例的结果可能有助于阐明抗肿瘤免疫和同种异体移植物耐受的机制，并为移植决策模型的更新提供信息。我们的报告还强调了在实体器官移植受者中进行临床试验测试新型免疫疗法组合的必要性，这些疗法旨在解耦抗肿瘤和抗同种异体移植物免疫。并开始解决先前接受过癌症免疫检查点抑制剂治疗的患者进行肾脏再移植的可行性。这个案例和未来案例的结果可能有助于阐明抗肿瘤免疫和同种异体移植物耐受的机制，并为移植决策模型的更新提供信息。我们的报告还强调了在实体器官移植受者中进行临床试验测试新型免疫疗法组合的必要性，这些疗法旨在解耦抗肿瘤和抗同种异体移植物免疫。并开始解决先前接受过癌症免疫检查点抑制剂治疗的患者进行肾脏再移植的可行性。这个案例和未来案例的结果可能有助于阐明抗肿瘤免疫和同种异体移植物耐受的机制，并为移植决策模型的更新提供信息。我们的报告还强调了在实体器官移植受者中进行临床试验测试新型免疫疗法组合的必要性，这些疗法旨在解耦抗肿瘤和抗同种异体移植物免疫。