| Summary: | Patients with lung transplantation are at a higher risk of malignancy, even compared to the general solid organ transplant community. There is little guidance for the treatment of malignancy in the setting of lung transplantation. This report describes the case of a patient with bilateral lung transplantation who subsequently developed three histologically distinct malignancies. He was treated with adjustment of immunosuppression, conventional chemotherapy, and an immune checkpoint inhibitor. His course was complicated by presumed allograft rejection, responsive to steroid treatment. Follow-up biopsy after rejection treatment was negative, prompting resumption of therapy, including immune checkpoint inhibition. He subsequently died secondary to progressive metastatic disease but, overall, lived 16 months after the diagnoses of metastatic cancer, a significant survival considering the high mortality of patients with lung transplantation and metastatic disease. This is the first report of immune checkpoint inhibition in the setting of multiple malignancies post-lung transplant and the fourth describing immune checkpoint inhibition after lung transplantation, three of which were significant for immune-mediated complications. Incorporation of patients with lung transplantation into clinical trials is necessary to definitively compare safety and efficacy of immune checkpoint inhibition and other agents in this population, which at present is unknown.
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