title: Belatacept for renal rescue in lung transplant patients.
abstract: Renal failure causes morbidity and mortality after lung transplantation and is aggravated by exposure to nephrotoxic immunosuppressant (IS) drugs. We report an off-label experience using belatacept for lung transplant recipients with severe renal insufficiency to reduce nephrotoxic IS exposure. We analyzed data retrospectively from a consecutive series of lung transplant patients with renal insufficiency in whom belatacept treatment was initiated between June 2012 and June 2014 at the University of Maryland Medical Center. Eight patients received belatacept because of acute or chronic renal insufficiency (median) GFR 24 (IQR 18-26). Glomerular filtration rate (GFR) remained stable in two patients and increased in five. One patient with established renal and respiratory failure received only the induction dose of belatacept and died 4 months later of respiratory and multisystem organ failure. Calcineurin inhibitor or sirolimus exposure was safely withheld or reduced without moderate or severe acute rejection during ongoing belatacept in the other seven patients. FEV1 remained stable over the 6-month study interval. Belatacept use appears to permit safe transient reduction in conventional immunosuppressive therapy and was associated with stable or improved renal function in a small retrospective series of lung transplant recipients with acute or chronic renal insufficiency.
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Irina
authors.initials: I
authors.lastname: Timofte
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Terrin
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Barr
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Pablo
authors.initials: P
authors.lastname: Sanchez
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: June
authors.initials: J
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, VA Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Reed
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Britt
authors.affiliation: Department of Pharmacy, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Bharath
authors.initials: B
authors.lastname: Ravichandran
authors.affiliation: Center for Advanced Heart Failure, Department of Cardiothoracic and Vascular Surgery, University of Texas-Huston, TX, USA.
authors.forename: Keshava
authors.initials: K
authors.lastname: Rajagopal
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Bartley
authors.initials: B
authors.lastname: Griffith
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Si
authors.initials: S
authors.lastname: Pham
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, VA Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Pierson
authors.affiliation: Departments of Medicine and Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Aldo
authors.initials: A
authors.lastname: Iacono
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D000368:Aged; D065095:Calcineurin Inhibitors / Q000737:chemistry; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects*; D008171:Lung Diseases / Q000150:complications* / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications* / Q000188:drug therapy*; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000069594:Abatacept; D020123:Sirolimus
keywords: belatacept; calcineurin inhibition; immunosuppression; lung transplant; renal failure