{
  "abstract": "Background Immune checkpoint inhibitors (ICIs) have become an essential component of modern oncology. 1 2 The use of ICIs have implications for solid organ transplantation. Studies show an increased probability of acute rejection in liver transplant recipients who have prior exposure to ICI.3 However, reports on ICI use and lung transplantation are limited and its effects on lung transplantation remain unclear. We evaluated 16 lung transplant cases in patients with prior ICI therapy.Methods We retrospectively reviewed patients who underwent bilateral orthotopic lung transplantation (BOLT) at Northwestern Memorial Hospital (Sep 2021-May 2025) after at least one cycle of ICI therapy. Patients were enrolled in the Double Lung Transplant REgistry Aimed for Lung-limited Malignancies (DREAM) study ( NCT05671887) across three cohorts: bilateral non-small cell lung cancer, pulmonary metastasis only disease, and history of malignancy within 5 years.Results Sixteen patients were analyzed. The median age was 58 years (range, 37–71), and 9 (56%) were female. Indication for BOLT was respiratory failure due to either malignant disease (n=13) and/or pulmonary disease such as ILD (n=2) or COPD (n=1).Pre-transplant ICI regimens included pembrolizumab-based therapies (n=7, 47%), nivolumab/ipilimumab (n=3, 20%), atezolizumab and durvalumab (n=2 each, 13%), and cemiplimab and toripalimab (n=1 each, 7%) (table 1).Median interval from last ICI to transplantation (washout period) was 34 weeks (range, 7–164 weeks); median ICI treatment duration was 5.5 months (range, 1–36 months). The median waitlist time to BOLT was 13 days (range, 2–66 days).There were no 30-day mortalities or episodes of acute cellular or antibody-mediated rejection. At a median follow-up of 15 months (range, 5–44), 15 patients remained alive with intact graft function; One death occurred at 6 months due to cardiac arrest presumed to be of cardiac etiology.Conclusions This is the first clinical report on the safety of ICI use prior to BOLT. Among 16 lung transplant recipients with prior exposure to immune checkpoint inhibitors, early and mid-term outcomes were excellent with no episodes of acute rejection or graft loss. These results suggest that previous immune checkpoint blockade is not an absolute barrier to successful lung transplantation. Larger, prospective studies with longer follow-up are needed to confirm safety and determine the optimal interval between the last ICI dose and transplantation.Trial Registration ClinicalTrials.gov NCT05671887References Song D, Zhao H, Wang Y, et al. Efficacy and safety of first-line PD-1/PD-L1 combined with CTLA-4 inhibitors in advanced non-small cell lung cancer: a meta-analysis. Front Immunol. 2024;15:1485303.Zhao H, Wang Y, Song D, et al. Immune checkpoint inhibitors in colorectal cancer: a meta-analysis of PD-1/PD-L1 plus CTLA-4 blockade. Front Immunol. 2024;15:1468972.Rezaee-Zavareh MS, Hajigholami A, Zhang X, et al. Impact of pre-transplant immune checkpoint inhibitor use on post-transplant outcomes in HCC: a systematic review and individual patient data meta-analysis. J Hepatol. 2024;82(1):107–119.Ethics Approval The study obtained ethics approval from the Northwestern University institutional review board (STU00217958). All patients signed informed consent.Consent Written informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.Abstract 560 Table 1Demographics",
  "authors": [
    {
      "affiliations": [
        "Northwestern University Feinberg School of Medicine, Chicago, IL, USA"
      ],
      "name": "Ronald Min"
    },
    {
      "affiliations": [
        "Rush Medical College of Rush University, Chicago, IL, USA"
      ],
      "name": "Ho Kim"
    },
    {
      "affiliations": [
        "Saint James School of Medicine, Arnos Vale, Saint Vincent and the Grenadines"
      ],
      "name": "Sangmi Yoo"
    },
    {
      "affiliations": [
        "Northwestern University Feinberg School of Medicine, Chicago, IL, USA"
      ],
      "name": "Liam Il-Young Chung"
    },
    {
      "affiliations": [
        "Northwestern University Feinberg School of Medicine, Chicago, IL, USA"
      ],
      "name": "Sanghwa Kim"
    },
    {
      "affiliations": [
        "Northwestern Memorial Hospital, Chicago, IL, USA"
      ],
      "name": "Brooke Sanson"
    },
    {
      "affiliations": [
        "Northwestern Memorial Hospital, Chicago, IL, USA"
      ],
      "name": "Rose Dwyer"
    },
    {
      "affiliations": [
        "Northwestern University Feinberg School of Medicine, Chicago, IL, USA"
      ],
      "name": "Tarik Demir"
    },
    {
      "affiliations": [
        "Northwestern University Feinberg School of Medicine, Chicago, IL, USA"
      ],
      "name": "Chitaru Kurihara"
    },
    {
      "affiliations": [
        "Northwestern University Feinberg School of Medicine, Chicago, IL, USA"
      ],
      "name": "Ankit Bharat"
    },
    {
      "affiliations": [
        "Northwestern University Lurie Comprehensive Cancer Center, Chicago, IL, USA"
      ],
      "name": "Young K Chae"
    }
  ],
  "title": "560 Impact of pre-transplant immune checkpoint inhibitor use on post-transplant outcomes in bilateral lung transplantation: case series",
  "uid": "c32f1fc4-e5d6-57be-b829-cf1dd55aafd9"
}