Navigating Immunotherapy in a Kidney Transplant Recipient: A Case Report of POLE-Mutated Jejunal Adenocarcinoma

Immunotherapy is a type of treatment that enhances the body’s own immune system to detect, target, and destroy cancer cells. This type of treatment is generally a less toxic alternative to traditional cancer therapies like chemotherapy and has revolutionized cancer treatment in the general population. However, immunotherapy for solid organ transplant patients has been excluded due to high risk of immune-mediated allograft rejection. We present a renal transplant recipient with metastatic small bowel adenocarcinoma harboring a POLE mutation who was treated with pembrolizumab and achieved a complete metabolic response on PET-CT with negative circulating tumor DNA. This case suggests that immune checkpoint inhibitors may be considered in carefully selected transplant recipients with high tumor mutational burden, though risks remain.