Immune Checkpoint Inhibitor Therapy in Transplant Recipients - UBC and BC Renal PWR 12.15.2023

Dr. Elena-Bianca Babir presents her talk, “Immune Checkpoint Inhibitor Therapy in Transplant Recipients,” as part of BC Renal’s province-wide rounds.
0:02:00 - Introduction
Dr. Babir starts by noting that she thinks there will be an increase in the use of immune checkpoint inhibitors (ICIs) in transplant recipients. Currently, ICIs are used to treat 50 different types of cancers. However, these work by boosting the immune’s system, which could in theory be harmful to transplant patients, who need suppressed immune systems to avoid rejection of their transplanted organs (allograft rejection).
Notably, cancer is starting to become almost as deadly as cardiovascular disease in transplant recipients. Dr. Babir discusses several reasons why transplant recipients might be at increased risk of cancer, including the fact that they are immunocompromised and tend to have worse outcomes due to comorbidities.
7:25 - Immune checkpoint inhibitors
Dr. Babir provides an overview of how immune checkpoint inhibitors work. She highlights two risks associated with use of ICIs, including risk of allograft rejection and the risk of blunting the anti-tumor activity of checkpoint inhibitors. However, she notes that rates of organ rejection have gone down in recent years, and that could be attributed to better methods of controlling the immune system in transplant patients.
0:14:25 - Study results
She highlights data on immune checkpoint inhibitor use in solid organ transplant recipients. When patients are not given ICI, cancer remains the primary cause of death. Of note, one study found that overall survival did not differ between those who experienced organ failure and those who did not. Based on her own study, evidence suggests it’s better to give ICIs to transplant recipients sooner in their cancer diagnosis.
0:36:00 - Protocols
Dr. Babir provides an overview of the protocol she uses when treating transplant recipients with cancer.
0:38:10 - Discussion
She encourages discussion between doctors and their patients about treatment with ICIs, risk of rejection and whether it’s worth the risk of returning to dialysis, as well as risk of cancer-related death. Dr. Babir notes many oncologists hesitate to have these discussions for various reasons (e.g., they may not be aware of the risks).
0:41:00 - Conclusion
She concludes that cancer is a leading cause of premature death in post kidney transplant patients, more so than allograft rejection. Yet data suggests that despite ICI use, there is a decreasing risk of rejection in recent years. Dr. Babir encourages doctors to have open conversations with their patients about these risks and their patients’ values.
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