Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_119_библиотеки_им_акад_М_И_Перельмана

single-center analysis at the Mayo Clinic further emphasizes the existing hetero­geneity of the data. They observed acute allograft rejection in one of seven kidney transplant patients included in their case series (14%). While all of their patients experienced a reduction in maintenance immunosuppression at the time of ICI initiation, only one of seven patients was on low-dose prednisone alone, one was on Sirolimus alone with a higher trough target, and the remainder were on two agents (4/7) and three agents (1/7). All patients who were maintained on mTOR inhibitors were targeting higher trough targets (Owoyemi et al., 2020). More recently, the only prospective study completed to date on the use of ICI therapy in kidney transplant patients, by Carroll etal., demonstrated a kidney allograft rejec­tion rate of 12%. In their study, Carroll etal. treated 16 kidney transplant recipients with PD1 inhibitors and 1 kidney transplant recipient with a PDL1 inhibitor. These patients all had stable allograft function with a creatinine less than 2mg/dl and were dened as low or intermediate immunologic risk based on the concentration of pre-formed donor- specic antibodies at the time of ICI therapy initiation (Carroll etal., 2022). None of these patients underwent pre-emptive reduction in their maintenance immunosuppression prior to initiation of ICI therapy, and nota­bly, the response to therapy was comparable to that seen in the general population of patients with cancer (Carroll etal., 2022). Carroll etal. described 24% complete responses and 29% partial responses with a 27.7 month median duration of response (Carroll etal., 2022). Comparably, in their recent systematic review of ICI use in all solid organ transplant recipients, Portuguese etal. reported an objec­tive response rate (ORR) of 68.2% in cutaneous SCC patients and 35.7% in cuta­neous melanoma patients (Portuguese etal., 2022). Objective response rate is the sum of complete responses and partial responses. These reported response rates are better than that reported in Murakami etal.’s earlier retrospective study look­ing at ICI use for the management of advanced squamous cell carcinoma (SCC) and cutaneous melanoma in 66 kidney transplant recipients (ORR 28.9%), many of whom did undergo a reduction in maintenance immunosuppression (Murakami et al., 2021).The lower rejection rates described by both Owoyemi et al. and Carroll etal. are likely attributable to the higher baseline maintenance immuno­suppression through ICI therapy. The systematic review by Portuguese etal. con­rmed that the rejection rate decreased as the number of maintenance immunosuppressive agents increased (Portuguese etal., 2022). Moreover, multi­ple studies have associated a switch to a mammalian target of rapamycin (mTOR) inhibitors at the time of ICI therapy initiation with a decreased risk of allograft rejection while maintaining the antitumor response of the ICI (Murakami etal.,