Elsevier

Transplantation Proceedings

Volume 48, Issue 9, November 2016, Pages 3137-3141
Transplantation Proceedings

Original contributions: Case reports
Kidney
Renal Allograft Failure After Ipilimumab Therapy for Metastatic Melanoma: A Case Report and Review of the Literature

https://doi.org/10.1016/j.transproceed.2016.07.019Get rights and content

Highlights

  • Ipilimumab is a biological agent that is used against malignant melanoma and is associated with autoimmune side effects.

  • We report on a case of renal transplant failure after initiation of ipilimumab as therapy against primary malignant melanoma, with evidence of acute cellular rejection and IgA nephropathy.

  • There is significant evidence from animal studies and case reports about the adverse effects of ipilimumab.

  • We highlight the importance of further study of this and related agents and the importance it plays in decision-making when initiating this form of therapy.

Abstract

Transplant recipients are at an increased risk of malignant melanoma, a result of chronic immunosuppression. Ipilimumab is a newer biological agent targeting T lymphocytes to potentiate an immune response against melanoma, and the use of this agent results in a new adverse effect profile that the clinician must be aware of while a patient is on therapy. We report the case of a male renal transplant recipient who developed graft failure while treated with ipilimumab and minimal immunosuppressive therapy for metastatic ocular melanoma, with biopsy evidence of glomerulonephritis and acute rejection. We highlight the immunological side effects that can manifest from ipilimumab therapy and conclude that it did influence graft function in this patient. Our case illustrates the importance of weighing the risks and benefits to graft function and long-term survival as well as the importance of considering other treatment modalities in this specific group of melanoma patients.

Section snippets

Case Report

We report the case of a 40-year-old male transplant recipient who underwent therapy with ipilimumab for metastatic ocular melanoma. At the age of 18 years, he developed chronic renal failure of an unknown aetiology. After a period of 2 years on peritoneal dialysis, he received a living related donor transplant from his mother in March 1994. After transplantation, his creatinine rose on day 5 and he was pre-emptively treated with methylprednisolone; a subsequent transplant biopsy demonstrated no

Discussion

The introduction of immunotherapy against cancer creates a further dimension of complexity, a result of the different adverse effects when compared with traditional treatment options. The CTLA-4 pathway plays a key role in the maintenance of self-tolerance and suppression of the immune response [7]. In the absence of CTLA-4 signaling, there is potentiation of the immune response through lymphocytic proliferation and interleukin production [10], [11]. Antagonizing the CTLA-4 receptor can be

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