The incidence of malignancy following long-term immunosuppression is increased in organ transplant recipients. We report a case of a patient with right ureteral and bladder cancer after living donor kidney transplantation for chronic glomerulonephritis and who was administered chemotherapy and immune checkpoint inhibitors. A 75-year-old male, 20 years post-living donor kidney transplantation for chronic glomerulonephritis, presented with malignant cells in urinary cytology. Despite initial treatments including transurethral resection of the bladder tumor, the tumor progressed to high-grade urothelial carcinoma. Computerized tomography results showed a right ureteral tumor and multiple lymph node metastases. Therefore, the patient underwent systemic chemotherapy with four cycles of gemcitabine and carboplatin. Pembrolizumab was administered due to rapid cancer progression
however, the cancer progressed further, and the patient was treated palliatively. The patient was treated with an immune checkpoint inhibitor with a reduced dose of immunosuppressive drugs with no rejection during the treatment course.