Tacrolimus to Belatacept Conversion Following Hand Transplantation: A Case Report

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
L CendalesA D Kirk

Abstract

Vascularized composite allotransplantation (VCA) has emerged as a viable limb replacement strategy for selected patients with upper limb amputation. However, allograft rejection has been seen in essentially all reported VCA recipients indicating a requirement for substantial immunosuppressive therapy. Calcineurin inhibitors have served as the centerpiece agent in all reported cases, and CNI-associated complications associated with the broad therapeutic effects and side effects of calcineurin inhibitors have been similarly common. Recently, belatacept has been approved as a calcineurin inhibitor replacement in kidney transplantation, but to date, its use in VCA has not been reported. Herein, we report on the case of a hand transplant recipient who developed recurrent acute rejection with alloantibody formation and concomitant calcineurin inhibitor nephrotoxicity, all of which resolved upon conversion from a maintenance regimen of tacrolimus, mycophenolate mofetil and steroids to belatacept and sirolimus. This case indicates that belatacept may be a reasonable maintenance immunosuppressive alternative for use in VCA, providing sufficient prophylaxis from rejection with a reduced side effect profile, the latter being particularly ...Continue Reading

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Citations

Mar 2, 2016·Transplant International : Official Journal of the European Society for Organ Transplantation·Fadi Issa
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Aug 31, 2021·Frontiers in Immunology·Dimitrios Moris, Linda C Cendales

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