title: Belatacept for Maintenance Immunosuppression in Lung Transplantation.
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.
authors.affiliation: UCSF Medical Center, San Francisco, CA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Hui
authors.affiliation: UCSF Medical Center, San Francisco, CA, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kern
authors.affiliation: UCSF Medical Center, San Francisco, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Wojciechowski
authors.affiliation: UCSF Medical Center, San Francisco, CA, USA.
authors.forename: Jasleen
authors.initials: J
authors.lastname: Kukreja
authors.affiliation: UCSF Medical Center, San Francisco, CA, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Golden
authors.affiliation: UCSF Medical Center, San Francisco, CA, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hays
authors.affiliation: UCSF Medical Center, San Francisco, CA, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Singer
keywords: Belatacept; lung transplant; novel immunosuppression; outcomes