Marco Donia: Checkpoint Inhibitors in Transplant Recipients – Graft Rejection and Tumor Regression
Marco Donia, Research Group Leader of the TIL group at CCIT (Center for Cancer Immune Therapy) and Professor at the University of Copenhagen, shared a post on LinkedIn about a paper by Nida Saleem et al. published in JAMA Oncology:
“Checkpoint inhibitors in transplant recipients: graft rejection and tumor regression (JAMA Oncology, Nida Saleem et al., June 2025)
For solid organ transplant recipients (SOTRs), immune checkpoint inhibitors (ICIs) bring two central dilemmas:
- The risk of graft rejection triggered by immune activation
- The risk of reduced anti-cancer efficacy due to the immunosuppression needed to prevent rejection
Meta-analysis of 343 SOTRs. Most were kidney transplant recipients (71%). About 75% had melanoma, cutaneous squamous cell carcinoma or hepatocellular carcinoma
Key points:
Rejection
- Acute rejection in 36% at 1 year; graft loss in 18%
- Most rejections occurred early (within 2 months of ICI start)
- About 60% of those who stopped calcineurin inhibitors (CNIs) and/or mTOR inhibitors at ICI initiation developed rejection
- mTOR inhibitors + steroids during ICI therapy: Significantly reduced rejection (HR 0.30, 95% CI 0.14-0.63), responses not reported
Efficacy
Objective response rate: 32%, similar to non-transplant populations
- 1 year OS 44% (across cancers)
- Median overall survival in patients with rejection: 5 months (lower than those without rejection)
Clinical implications
- ICIs are a viable option for selected SOTRs
- Early rejection is common
- Avoiding abrupt discontinuation of baseline immunosuppression and/or use of mTOR+low dose steroids may improve safety.”
Title: Outcomes of Solid Organ Transplant Recipients With Advanced Cancers Receiving Immune Checkpoint Inhibitors
Authors: Nida Saleem, Jiayue Wang, Angela Rejuso, Armando Teixeira-Pinto, Jacqueline H. Stephens, Annabelle Wilson, Anh Kieu, Ryan P. Gately, Farzaneh Boroumand, Edmund Chung, Billie Bonevski, Matteo S. Carlino, Robert Carroll, Wai H. Lim, Jonathan C. Craig, Naoka Murakami, Germaine Wong.
You can read the Full Article in JAMA Oncology.
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