Table 4.
Immunosuppression management in kidney transplant patients around the time of immune checkpoint inhibitor therapy
| Variable | Rejection (N = 18) | No rejection (N = 25a) |
|---|---|---|
| Time from kidney transplantation to cancer development, mo | 135 (103) | 91 (92) |
| Baseline creatinine at the time of immune checkpoint inhibitor therapy, mg/dl | 1.3 (0.56) | 1.4 (0.4) |
| Baseline eGFR at the time of immune checkpoint inhibitor therapy, ml/min | 63.8 (15.4) | 53.2 (16.7) |
| Maintenance immunosuppression at the time of cancer diagnosis | ||
| CNI | 1 (7.6) | — |
| CNI/MMF | 3 (23) | 2 (11.7) |
| CNI/steroid | 2 (15.3) | 4 (23.5) |
| CNI/MMF/steroid | 4 (30.7) | 10 (23.5) |
| CNI/AZA/steroid | 3 (23.0) | — |
| mTOR/steroid | — | 1 (5.8) |
| Not available | 5 | 8 |
| Change in immunosuppression at the time of cancer diagnosis | ||
| No change | 3 (33.3) | 6 (50) |
| Reduction in dose alone | 2 (22.2) | — |
| Stop CNI alone | 1 (11.1) | 1 (8.3) |
| CNI to mTOR alone | 1 (11.1) | 3 (25) |
| CNI to mTOR + stop MMF | 2 (22.2) | 1 (8.3) |
| Not available | 9 | 13 |
| Planned change in immunosuppression at the time of immune checkpoint inhibitor therapy | ||
| No change | — | 8 (34.7) |
| Reduction in dose alone | 2 (11.7) | 1 (4.3) |
| Stop MMF | — | 1 (4.3) |
| CNI to mTOR | 2 (11.7) | 1 (4.3) |
| CNI to mTOR + stop MMF | 1 (5.8) | 1 (4.3) |
| Steroid alone | 8 (47) | 3 (13.0) |
| Baseline immunosuppression data not available for comparison | — | 8 (34.7) |
| Missing data | 1 | 2 |
AZA, azathioprine; CNI, calcineurin inhibitor; eGFR, estimated glomerular filtration rate; MMF, mycophenolate mofetil; mTOR, mammalian target of rapamycin inhibitor.
a
One patient excluded due to nephrectomy before immune checkpoint blockade.