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Tacrolimus to Belatacept Conversion Following Hand Transplantation: A Case Report.
L Cendales1, R Bray2, H Gebel2
1Department of Surgery, Duke University School of Medicine, Durham, NC.
Summary
Vascularized composite allotransplantation (VCA) requires significant immunosuppression, often causing side effects. This case study suggests belatacept may offer effective rejection prophylaxis for VCA with a better side effect profile.
Area of Science:
- Immunology
- Transplantation Surgery
- Nephrology
Background:
- Vascularized composite allotransplantation (VCA) is a limb replacement option for amputees.
- Current immunosuppression relies heavily on calcineurin inhibitors (CNIs), leading to frequent complications.
- Belatacept, an alternative to CNIs in kidney transplants, has not been studied in VCA.
Observation:
- A hand transplant recipient experienced recurrent acute rejection and CNI-induced nephrotoxicity.
- The patient was on a maintenance regimen including tacrolimus, mycophenolate mofetil, and steroids.
- Conversion to belatacept and sirolimus resolved rejection and nephrotoxicity.
Findings:
- Belatacept effectively prevented rejection in this VCA case.
- Switching to belatacept reduced CNI-associated nephrotoxicity.
- The patient tolerated the new immunosuppressive regimen well.
Implications:
- Belatacept represents a potential alternative maintenance immunosuppressant for VCA.
- This approach may mitigate CNI-related side effects in VCA recipients.
- Belatacept could improve long-term outcomes for VCA patients, especially for non-life-threatening indications.
Keywords:
clinical research/practicecostimulationimmunosuppressantvascularized composite and reconstructive transplantation
