Original contributions: Case reportsKidneyRenal Allograft Failure After Ipilimumab Therapy for Metastatic Melanoma: A Case Report and Review of the Literature

- Ipilimumab is a biological agent that is used against malignant melanoma and is associated with autoimmune side effects.
- We report on a case of renal transplant failure after initiation of ipilimumab as therapy against primary malignant melanoma, with evidence of acute cellular rejection and IgA nephropathy.
- There is significant evidence from animal studies and case reports about the adverse effects of ipilimumab.
- We highlight the importance of further study of this and related agents and the importance it plays in decision-making when initiating this form of therapy.

Transplant recipients are at an increased risk of malignant melanoma, a result of chronic immunosuppression. Ipilimumab is a newer biological agent targeting T lymphocytes to potentiate an immune response against melanoma, and the use of this agent results in a new adverse effect profile that the clinician must be aware of while a patient is on therapy. We report the case of a male renal transplant recipient who developed graft failure while treated with ipilimumab and minimal immunosuppressive therapy for metastatic ocular melanoma, with biopsy evidence of glomerulonephritis and acute rejection. We highlight the immunological side effects that can manifest from ipilimumab therapy and conclude that it did influence graft function in this patient. Our case illustrates the importance of weighing the risks and benefits to graft function and long-term survival as well as the importance of considering other treatment modalities in this specific group of melanoma patients.