title: Late onset Pneumocystis pneumonia in renal transplantation after long-term immunosuppression with belatacept.
abstract: Interference with T-cell function increases the risk of infections, especially during the early post-transplant period. Belatacept, a costimulation blocker, is currently being tested in phase III clinical trials. Here we report a renal transplant recipient who received belatacept and developed severe Pneumocystis jirovecii pneumonia (PCP) with fatal superinfections 4 years post transplant. Cytomegalovirus infection preceded PCP, which typically occurs in overimmunosuppressed patients, but has not yet been reported under T-cell costimulation blockade in transplant patients. This case illustrates the possibility of excessive immunosuppression even with a lymphocyte-specific regimen.
authors.affiliation: Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Haidinger
authors.forename: M
authors.initials: M
authors.lastname: Hecking
authors.forename: M
authors.initials: M
authors.lastname: Memarsadeghi
authors.forename: T
authors.initials: T
authors.lastname: Weichhart
authors.forename: J
authors.initials: J
authors.lastname: Werzowa
authors.forename: W H
authors.initials: WH
authors.lastname: Hörl
authors.forename: M D
authors.initials: MD
authors.lastname: Säemann
mesh_terms: D000069594:Abatacept; D017809:Fatal Outcome; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D018796:Immunoconjugates / Q000009:adverse effects* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D015163:Superinfection / Q000000981:diagnostic imaging / Q000209:etiology*
chemical_list: D018796:Immunoconjugates; D007166:Immunosuppressive Agents; D000069594:Abatacept