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CASE REPORT article
Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1506324
Combined standard immunosuppression and immune checkpoint inhibition for BKPyV+ metastatic renal cell carcinoma of the graft in a kidney transplant recipient with chronic rejection: a case report
Provisionally accepted
Ilaria Gandolfini 1
Martina Manini 2
Giuseppe Daniele Benigno 1 Micaela Gentile 1 Alessandra Palmisano 1 Danio Somenzi 3 Letizia Gnetti 1
Marco Delsante 1
Benedetta Mordà 2 Marta D'angelo 2 Daniel Salvetti 2
Enrico Fiaccadori 2
Sebastiano Buti 2
Umberto Maggiore 2*- 1 University Hospital of Parma, Parma, Emilia-Romagna, Italy
- 2 Department of Medicine and Surgery, University of Parma, Parma, Italy
- 3 Nephrology and Dialysis, Reggio Emilia IRCCS, Reggio Emilia, Italy
We report the first case of a dual kidney transplant recipient diagnosed with a metastatic BK polyomavirus-positive clear renal cell carcinoma with sarcomatoid features, causing extensive vena cava thrombosis. The patient was successfully treated with Immune Checkpoint Inhibitors (ICIs) ipilimumab plus nivolumab and continued immunosuppression with tacrolimus, mycophenolate and steroids. He received ICIs despite the presence of graft dysfunction due to transplant glomerulopathy. As expected, ICIs treatment caused a progressive but asymptomatic decline of the graft function which resulted in end-stage kidney disease. However, continuation of a full immunosuppression prevented acute rejection, graft intolerance syndrome episodes or dual graft nephrectomy, enabling the patient to successfully continue ICIs while on dialysis and to achieve sustained partial remission at 17-months of follow-up.
Keywords: immune checkpoint inhibitors, immunosuppression, BK virus, renal cell carcinoma, kidney transplantation, dialysis Abbreviations: BKPyV, BK polyomavirus, ICIs, Immune checkpoint inhibitors, DSA, anti-HLA donor-specific antibodies, SV40, Simian virus 40, CT, computed tomography, MRI, magnetic resonance imaging, CAIX, carbonic anhydrase IX, PAX8, paired box gene 8
Received: 04 Oct 2024; Accepted: 19 Feb 2025.
Copyright: © 2025 Gandolfini, Manini, Benigno, Gentile, Palmisano, Somenzi, Gnetti, Delsante, Mordà , D'angelo, Salvetti, Fiaccadori, Buti and Maggiore. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Umberto Maggiore, Department of Medicine and Surgery, University of Parma, Parma, Italy
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