Use of Immun Checkpoint Inhibitor Iplimumab in Renal Transplant Patents with Advanced Cancer: Is Risk/Benefit Ratio Dilemma?

End stage kidney disease is one of the most common diseases seen worldwide with high morbidity and mortality rate. Given current renal replacement therapies, the most effective method is renal transplantation compared to dialysis. Renal transplantation improves the patient's quality of life and complications related to dialysis are minimized. Long-term immunosuppressant therapy is applied to transplantation patients to ensure organ continuity by reducing the risk of acute rejection. Survival time after renal transplantation and increased use of immunosuppressive drugs increase the risk of developing metastatic tumors in these patients. It is predicted that immune checkpoint inhibitors applied to cancer patients can be used in patients with cancer development after transplantation. Ipilimumab is a cytotoxic T-lymhocyte-associated antigen 4 (CTLA-4) inhibitor developed specifically for use in metastatic melanoma patients and approved by the FDA in 2011. The effect of ipilimumab on allograft survival has been reported compared to other immune checkpoint inhibitors. Based on these data, we examined the renal case reports available in the literature to evaluate the relationship between cancer outcome and graft rejection.