Cytokine storm induced by a PD1 inhibitor in a renal transplant patient.

Transplant patients are excluded from immunotherapy trials and therefore require more attention if such a treatment is deemed necessary. There should be an established procedure for managing immune-related adverse events (irAEs) secondary to PD-1/PD-L1 blockade because of the high rejection rate (371 to 80% 2,3 ) and the subsequent mortality, especially in non-kidney recipients3 ,4 . CTLA4 agonist has been identified as a nivolumab antidote for fulminant myocarditis in naive patients but it may be insufficient in primed patients with a much stronger alloimmune response.