Immunotherapy Considerations in Solid Organ Transplant Recipients

Dr Whitman poses a variation on the second case, asking how management would change if the patient were a kidney transplant recipient rather than a patient with chronic kidney disease alone. Dr In discusses the central tension in treating solid organ transplant recipients with checkpoint inhibitors, weighing the risk of allograft rejection against the risk of progressive and potentially fatal cutaneous squamous cell carcinoma. The faculty consider how the identity of the transplanted organ shapes that calculation, noting that loss of a kidney allograft, while serious, leaves dialysis as a viable option, whereas rejection of a lung or heart allograft carries far more immediate consequences. Both emphasize close coordination with the transplant team, careful informed consent, and individualized decision-making. Dr In also references ongoing efforts to study checkpoint inhibitor therapy prospectively in transplant recipients, a population historically excluded from registrational trials in advanced cutaneous squamous cell carcinoma.