title: Complete Regression of Psoriatic Arthritis After Belatacept Conversion in a Highly HLA-Sensitized Kidney Transplant Patient.
abstract: Costimulatory inhibitors (i.e. abatacept and belatacept) effectively abrogate T lymphocyte activation and proliferation and have been shown to be effective for disease control in certain autoimmune disorders as well as in preventing allograft rejection in kidney transplantation. Whether such immunomodulatory agents may be useful for the control of autoimmune flares and allograft acceptance, while avoiding the need of additional strong immunosuppressants, has not been shown. Here, we report the first case of a 47-year-old man affected by a serious debilitating form of psoriatic arthritis that presented during the course of a third, high immunological-risk kidney transplantation. Three years after transplantation, the patient benefited by switching from tacrolimus- to belatacept-based therapy, without additional immunosuppression, by showing complete regression of the arthritic symptoms as well as no progression of severe radiological lesions, which leaded to the recovery of disability and functional impairment. Remarkably, the treatment with belatacept in association with mycophenolate mofetil and steroids also provided a stable normal allograft function over time and abrogated the development of de novo circulating donor-specific alloantibodies after 4 years of follow-up.
authors.affiliation: Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona University, IDIBELL, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Meneghini
authors.affiliation: Rheumatology Department, Bellvitge University Hospital, Barcelona University, IDIBELL, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gómez
authors.affiliation: Radiology Department, Bellvitge University Hospital, Barcelona University, IDIBELL, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Mast
authors.affiliation: Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona University, IDIBELL, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Melilli
authors.affiliation: Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona University, IDIBELL, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Grinyó
authors.affiliation: Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona University, IDIBELL, Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Bestard
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000139:chemically induced / Q000188:drug therapy*; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D007166:Immunosuppressive Agents; D000069594:Abatacept
keywords: clinical research/practice; comorbidities; costimulation; dermatology; fusion proteins and monoclonal antibodies: belatacept; immunosuppressant; immunosuppression/immune modulation; kidney transplantation/nephrology