Abstract
Belatacept is a novel immunosuppressant that blocks a T-cell costimulation pathway and is approved for use in adult kidney transplant recipients. Its safety and efficacy have not been established after lung transplantation. We present a case of a lung transplant recipient treated with belatacept. A 56-year-old man underwent bilateral lung retransplantation for bronchiolitis obliterans syndrome (BOS). In the third year posttransplant, he developed hemolytic uremic syndrome (HUS) attributed to tacrolimus. Tacrolimus was changed to sirolimus. One month later, he presented with worsening renal function and HUS attributed to sirolimus. Plasmapheresis and steroid pulse were initiated with clinical improvement, and sirolimus was switched to belatacept. He experienced no episodes of cellular rejection but developed recurrent BOS. Complications during treatment included anemia and recurrent pneumonias. The safety and efficacy of belatacept in lung transplantation remains unclear; further studies are needed.
Highlights
Maintenance immunosuppression is imperative to maintain allograft function after lung transplant
We present a case of a lung transplant recipient who developed hemolytic uremic syndrome (HUS) secondary to tacrolimus and subsequently sirolimus, who was switched to belatacept
We present our center’s experience of belatacept use in a lung transplant recipient
Summary
Maintenance immunosuppression is imperative to maintain allograft function after lung transplant. Belatacept is a novel immunosuppressant approved for use in adult kidney transplantation, but has not been studied in lung transplantation.
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