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Naoka Murakami and Ala Abudayyeh

Cancer is a major cause of death in patients with kidney transplants. The incidence of cancer after transplant is 3- to 100-fold higher than that in the general population, and cancer has been shown to be one of the most feared outcomes in patients with kidney transplants (1, 2). However, data on cancer screening and treatment efficacies of novel cancer therapies in patients with kidney transplants are lacking, as these patients have been typically excluded from clinical studies.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and become standard therapy for many cancers. They work by

Sonia Rodriguez-Ramirez and Naoka Murakami
Case description

A 23-year-old female with primary focal segmental glomerulosclerosis (FSGS), diagnosed at the age of 16, underwent a living-related kidney transplantation (KT). She was on hemodialysis for 2 years before transplant but still had residual urine output of 500 mL/day with a random urine protein-to-creatinine ratio (UPCR) of 1.5 g/gCr. On post-operative day 4, UPCR was noted as 14 g/gCr. A kidney allograft biopsy demonstrated diffuse effacement of podocyte foot processes with no evidence of acute rejection.

What are the risk factors and mechanisms of recurrent primary FSGS posttransplant? What treatment options (pre- and posttransplant) might benefit this patient?

Brittany Schreiber, Kevin Fowler, and Naoka Murakami

Onco-nephrology is evolving as an important subspecialty in transplant care. Brittany Schreiber (BS), a renal fellow, interviews Kevin Fowler (KF), a kidney transplant recipient, and Naoka Murakami (NM), a transplant nephrologist.

BS: Why are you interested in onco-nephrology?

KF: I received a preemptive kidney transplant in 2004, and due to chronic immunosuppression, I have had several episodes of cancer. Fortunately, all of the episodes were successfully resolved, but the pathway to treatment success has not always been clear. For example, when I was diagnosed with prostate cancer, I had to navigate a landscape where I felt alone. I received