Purpose: B7-H1 is expressed by clinically aggressive forms of renal cell carcinoma (RCC) and predicts adverse outcome. B7-H1 is known to impair host immunity via interaction with the Programmed Death-1 (PD-1) receptor, which is expressed by activated Tcells. Levels of immune cells expressing PD-1 (PD-1 + ) in clinical RCC tumors have not been evaluated. Thus, we tested whether immune cell PD-1expression is observed within aggressive RCC tumors. Experimental Design: Between 2000 and 2003, 267 patients underwent nephrectomy at our institution for clear cell RCC and had fresh-frozen tissue available for review. These RCC specimens were immunostained using anti^PD-1 (clone MIH4) and outcome analyses were conducted.Results: Mononuclear immune cell infiltration was observed in 136 (50.9%) specimens. PD-1 + immune cells were present in 77 of these 136 (56.6%) tumors. In contrast, RCC tumor cells did not express PD-1. Patients with PD-1 + immune cells were significantly more likely to harbor B7-H1 + tumor cells (P < 0.001), larger tumors (P = 0.001), and tumors of higher nuclear grade (P = 0.001). Likewise, intratumoral PD-1 + immune cells were associated with advanced tumor-node-metastasis stage (P = 0.005), coagulative tumor necrosis (P = 0.027), and sarcomatoid differentiation (P = 0.008). With a median follow-up of 2.9 years, 52 patients died from RCC. Univariately, patients with PD-1 + immune cells were at significant risk of cancer-specific death compared with PD-1 À patients (risk ratio, 2.24; P = 0.004). Conclusions: Levels of immune cells expressing PD-1were increased in patients with high-risk RCC tumors. Interactions between immune cell PD-1and B7-H1may promote cancer progression by contributing to immune dysfunction in patients with RCC.Renal cell carcinoma (RCC) is an immunogenic tumor that characteristically harbors abundant infiltrating lymphocytes (1). Several reports, however, indicate that lymphocytes within RCC tumors are often rendered dysfunctional (2 -4). Thus, it seems that RCC tumors possess a potent regional ability to impair host antitumor immunity. Elucidating mechanisms responsible for immune dysfunction within the tumor microenvironment may prove useful to improve immunotherapeutic approaches for the treatment of RCC.The Programmed Death-1 (PD-1) receptor was first described in 1992 (5) as a member of the B7 family of costimulatory molecules that modulate T cell antigen-specific receptor signaling and govern T cell activation, inactivation, and survival (6). Membranous expression of the PD-1 glycoprotein has been described in association with activated T cells, B cells, and mature dendritic cells (7). Murine studies indicate that PD-1 functions as a negative regulator of immune responses, as is supported by the development of autoimmune glomerulonephritis, arthritis, and cardiomyopathy in PD-1 knockout mice (8).One known ligand for PD-1, B7-H1 (PD-L1, CD274), has been extensively studied in patients with RCC. We have reported that B7-H1 is aberrantly expressed by both primary and me...