Acute renal transplant rejection following nivolumab therapy for metastatic melanoma

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.

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Clinically Significant Drug−Drug Interaction Between Tacrolimus and Phenobarbital

Journal of Pharmacy Practice ◽

10.1177/0897190010377804 ◽

2010 ◽

Vol 23 (6) ◽

pp. 585-589 ◽

Cited By ~ 10

Author(s):

Nida Siddiqi ◽

Kwaku Marfo

Keyword(s):

Drug Interaction ◽

Renal Transplant ◽

Drug Interactions ◽

Transplant Rejection ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Patient Identification ◽

Clinically Significant ◽

Trough Levels ◽

Renal Transplant Rejection

Purpose: The case of a 57-year-old male who experienced acute renal transplant rejection due to subtherapeutic tacrolimus levels as a result of drug interaction with phenobarbital. Summary: Drug interactions with tacrolimus due to its metabolism through the CYP 450 3A4 enzymatic pathway have led to several reports of altered tacrolimus levels, which can lead to acute rejection in renal transplant recipients. We describe the case of a 57-year-old male initiated on immunosuppressive therapy with tacrolimus in addition to his anticonvulsant medications. Conclusion: Upon tacrolimus dose increases, discontinuation of carbamazepine, and minimization of phenobarbital dose, effective tacrolimus trough levels were achieved in our patient. Identification and elimination of such drug−drug interactions is necessary to assure adequate immunosuppression in renal transplant recipients.

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Indicators of acute renal-transplant rejection in patients treated with cyclosporine

Clinical Chemistry ◽

10.1093/clinchem/36.5.759 ◽

1990 ◽

Vol 36 (5) ◽

pp. 759-764 ◽

Cited By ~ 14

Author(s):

P W Mueller ◽

V Delaney ◽

M L MacNeil ◽

S P Caudill ◽

K K Steinberg

Keyword(s):

Renal Transplant ◽

Sensitivity And Specificity ◽

Activity Ratio ◽

Transplant Rejection ◽

Plasma Creatinine ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Alanine Aminopeptidase ◽

Optimal Values ◽

Renal Transplant Rejection

Abstract We evaluated the ability of three enzymes--N-acetyl-beta-D-glucosaminidase (NAG; EC 3.2.1.30), alanine aminopeptidase (AAP; microsomal aminopeptidase, EC 3.4.11.2), and gamma-glutamyltransferase (GGT; EC 2.3.2.2)--and adenosine deaminase binding protein (ABP) in urine to predict or confirm renal-transplant rejection in patients treated with cyclosporine. We measured the enzymes daily during the early post-transplant hospital stay of 104 renal-transplant recipients (72 men and 32 women). We also measured ABP in 32 of these patients. We analyzed the data by calculating the activity ratio of each day's test value to the previous day's result and optimized the sensitivity (SN) and specificity (SP) to determine the optimal ratio for each test. The results indicate that cyclosporine treatment reduces the optimal sensitivity and specificity of these tests. Three comparable tests (ABP, GGT, and AAP) yield the best optimal values (SN = 0.77, 0.69, 0.77; and SP = 0.71, 0.74, 0.63, respectively), and the NAG test yields the lowest combination of sensitivity and specificity (SN = 0.62, SP = 0.66). All four tests were less sensitive and specific than the plasma creatinine test (optimal day-to-day difference = 5 mg/L). However, the ABP and AAP tests gave indications of rejection at least 24 h before clinical diagnosis for 50% of the patients experiencing rejection, while early plasma creatinine increases of 5 mg/L occurred in only 19% of this group.

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Sulphinpyrazone Does Not Influence Rejection Of Renal Transplants

10.1055/s-0038-1652029 ◽

1981 ◽

Author(s):

J H Turney ◽

M Bewick ◽

M J Weston

Keyword(s):

Renal Transplantation ◽

Renal Transplant ◽

Transplant Rejection ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Fibrin Deposition ◽

Chi Squared ◽

And Function ◽

To Receive ◽

Renal Transplant Rejection

Platelet-mediated intravascular fibrin deposition may be the distal arm of the transplant rejection process. There have been reports that anti pi ate let drugs may prevent ameliorate, or even reverse renal transplant rejection. 50 consecutive cadaveric renal transplant recipients were randomly allocated to receive sulphinpyrazone 400 mg twice daily or no treatment additional to conventional immunosuppressive therapy. Patients were followed for 6 months, at which time they were assessed for graft survival and function, and for the number of rejection episodes. Rejection was defined as a rise in serum creatinine for which no other explanation was identified. Results were analysed by the Chi-squared test with Yates’ correction. Results at 6 months: There were no differences between the two groups, neither did the function of the surviving grafts differ.We conclude that, in this study, antiplatelet therapy with sulphinpyrazone does not affect the outcome of cadaveric renal transplantation.

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Chemokine Receptor Polymorphism and Risk of Acute Rejection in Human Renal Transplantation

Journal of the American Society of Nephrology ◽

10.1681/asn.v133754 ◽

2002 ◽

Vol 13 (3) ◽

pp. 754-758 ◽

Cited By ~ 2

Author(s):

Reza Abdi ◽

Tran Thi Bich Huong ◽

Alfredo Sahagun-Ruiz ◽

Philip M. Murphy ◽

Barry M. Brenner ◽

...

Keyword(s):

Renal Transplantation ◽

Renal Transplant ◽

Acute Rejection ◽

Chemokine Receptor ◽

Chemokine Receptors ◽

Renal Allograft ◽

Transplant Rejection ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Renal Transplant Rejection

ABSTRACT. Chemokines regulate the trafficking of leukocytes in immunity and inflammation and have been implicated in mouse models in acute cardiac and renal allograft rejection; however, their significance to human transplantation is not yet defined. The association of human chemokine receptor genetic variants, CCR5-Δ32, CCR5-59029-A/G, CCR2-V64I, CX3CR1-V249I, and CX3CR1-T280M, with outcome in 163 renal transplant recipients was examined here. Significant reductions were found in risk of acute renal transplant rejection in recipients who possessed the CCR2-64I allele (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.12 to 0.78; P = 0.014) or who were homozygous for the 59029-A allele (OR, 0.37; 95% CI, 0.16 to 0.85; P = 0.016). There were no significant differences in the incidence of rejection among patients stratified as with or without CCR5-Δ32 or by the CX3CR1-V249I or CX3CR1-T280M genotypes. Adjustment for known risk factors for transplant rejection confirmed the univariate findings for possession of the CCR2-64I allele (OR, 0.20; P = 0.032) and homozygosity for the 59029-A allele (OR, 0.26; P = 0.027). It was concluded that the risk of acute rejection in renal transplantation is associated with genetic variation in the chemokine receptors CCR2 and CCR5.

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