Organ transplant recipients in Australia face a high risk of cancer, especially skin cancers, and their cancer-related death rate is two to three times higher than that of the general population.
This is largely due to the fact that doctors must carefully reduce immune suppression to help fight cancer, while still protecting the transplanted organ from rejection.
Now, a multi-institutional study led by researcher, Dr Nida Saleem from Western Sydney Local Health District, in collaboration with Flinders University’s FHMRI and the University of Sydney, systematically reviewed data from 343 transplant recipients worldwide.
Made possible with support from Westmead Hospital Foundation, this study has shown that organ transplant patients with cancer may respond similarly to the general population to a type of cancer treatment called immune checkpoint inhibitors (ICIs).
“What excited me about this research is the possibility that ICIs may offer some of these patients a longer life with tailored care.
“By identifying who is most likely to benefit and who is at higher risk of complications, treatment decisions can be more personalised and made in partnership with patients,” Dr Saleem said.
ICIs were previously excluded from similar clinical trials due to the risk that they could trigger organ rejection, and because the immune-suppressing medications might reduce the cancer-fighting effects of these drugs.
“Among all transplant recipients studied, about one in three responded positively to ICI treatment after one year, a success rate on par with patients who had never undergone a transplant. However, about 36% still experienced rejection within one year of starting ICI treatment,’ says Dr Saleem.
Dr Saleem says the risk of rejection and subsequent transplant loss with ICI treatment can be reduced in organ transplant patients in other ways.
Our research shows careful adjustment of immunosuppressive therapy, such as combining mTOR inhibitors and steroids, may also help protect the transplanted organ while still allowing the cancer treatment to work.”
Dr Saleem’s study, published in JAMA Oncology, shows organ transplant patients with skin cancers may respond particularly well to ICIs.
“For patients, for example, with certain cancers like squamous cell carcinoma where a cancer response reaches around 60% in the first year after treatment, and those who are kidney transplant recipients, starting ICI treatments earlier, along with immune-suppressing drugs, may improve cancer control while lowering the risk of losing the transplant and potentially have a survival comparable to the general population.”
“In contrast, patients with other organ transplants may require a more cautious and highly individualised strategy, due to limited organ replacement options in the instance of transplant rejection,” Nida said.
Looking ahead, there’s a clear need for controlled studies comparing ICI therapy with standard anti-cancer treatments in transplant populations.
A multicentre international collaboration, and importantly, including the voices of transplant recipients in research design, will be essential to expand treatment options for this vulnerable group safely.
“This research helps bridge that gap, showing that ICIs may still benefit in carefully selected transplant patients, particularly those with cutaneous squamous cell carcinoma, one of the most common post-transplant cancers in Australia.
“The findings highlight the importance of personalised treatment strategies and suggest that, with careful immunosuppressive management, ICIs could be a viable option, particularly when conventional cancer treatments are ineffective,” Dr Saleem said.
This study was made possible with the support of donors through Westmead Hospital Foundation.
If you would like to support future research within Westmead Hospital, please visit the Westmead Hospital Foundation website https://www.westmeadhf.org.au/
Read Dr Saleem’s full study as published in JAMA Oncology, doi: 10.1001/jamaoncol.2025.2374