Purpose Combined immunotherapy of nivolumab plus ipilimumab for intermediate- and poor-risk metastatic clear cell renal cell carcinoma showed prolonged progression-free survival and high objective response rate in a randomized phase III clinical trial. However, the efficacy of this treatment for papillary renal cell carcinoma remains unclear. In the present study, we analysed the efficacy of nivolumab plus ipilimumab therapy for papillary renal cell carcinoma compared with that for clear cell renal cell carcinoma. Materials and Methods This is a retrospective study of 30 patients with metastatic renal cell carcinoma who received nivolumab and ipilimumab as first-line therapy between December 2015 and May 2020. The objective response rate, progression-free survival and toxicity were compared between the two groups (clear cell renal cell carcinoma and papillary renal cell carcinoma). Results Out of 30 patients, 7 and 23 were diagnosed with papillary renal cell carcinoma and clear cell renal cell carcinoma, respectively. With a median follow-up of 7.2 months, the median progression-free survival was significantly shorter in papillary renal cell carcinoma than in clear cell renal cell carcinoma (2.4 vs. 28.1 months, P = 0.014). Of the seven patients with papillary renal cell carcinoma, one had partial response, one had stable disease and five had progressive disease, resulting in an objective response rate of 14.2%, which was lower compared to that of clear cell renal cell carcinoma (14.2 vs. 52.1%, P = 0.06). Discontinuation due to toxicity was not observed with papillary renal cell carcinoma, meanwhile 60.8% of patient with clear cell renal cell carcinoma discontinued treatment due to toxicity. Conclusion Nivolumab plus ipilimumab had modest efficacy for papillary renal cell carcinoma compared with that for clear cell renal cell carcinoma. Nivolumab plus ipilimumab remains an option for a limited number of patients with intermediate- or poor-risk papillary renal cell carcinoma.

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ABSTRACT:Aim: We discuss the clinicopathological analysis of cases of chronic vascular rejection (CVR) cases after renal transplantation and clarify the mechanisms underlying the development and prognostic significance of CVR. Loss of the renal allograft occurred during the observation period in nine of the patients (26%). Of the remaining patients with functioning grafts, deterioration of the renal allograft function after the biopsies occurred in 11 patients (32%). Patients: CVR was diagnosed in Conclusion:The results of our study suggest that AMR may underlie CVR in many cases, while T cell-mediated rejection may play an important role in some cases. Chronic vascular rejection (CVR) is a morphologic pattern of chronic kidney allograft injury.1 CVR is vascular changes potentially enable identification of kidneys with chronic/ sclerosing changes due to chronic rejection, described in the Banff 1997 classification.1 While numerous reports have been published on acute vascular rejection (AVR) after kidney transplantation (KTx), which is assigned a 'v' score in the Banff 1997 classification, there are but a few reports on CVR. [2][3][4][5][6] In this report, we present the results of our clinical and pathological analyses of cases of CVR after KTx, and attempt to clarify the underlying mechanisms and prognostic significance of CVR. MATERIALS AND METHODSDuring the period from January 2009 to December 2013, CVR was diagnosed in 46 renal allograft biopsy specimens (BS) obtained from 34 renal transplant patients who were being followed up at the Department of Urology, Tokyo Women's Medical University. The data obtained from the 46 BS and 34 patients were retrospectively reviewed from the clinical records and constituted the subjects of this study. The immunosuppressive protocol mainly consisted of triple-drug therapy with methylprednisolone (MP), cyclosporine (CYA) or tacrolimus (TAC), and mizoribine (MZ), azathioprine (AZ) bs_bs_banner Nephrology 20, Suppl. 2 (2015) 20-25

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