Tacrolimus to Belatacept Conversion Following Hand Transplantation: A Case Report

L. Cendales*, R. Bray, H. Gebel, L. Brewster, R. Elbein, D. Farthing, M. Song, D. Parker, A. Stillman, T. Pearson, A. D. Kirk

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

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 relevant for nonlife threatening conditions typically treated by VCA.

Original languageEnglish
Pages (from-to)2250-2255
Number of pages6
JournalAmerican Journal of Transplantation
Volume15
Issue number8
DOIs
StatePublished - 1 Aug 2015
Externally publishedYes

Keywords

  • clinical research/practice
  • costimulation
  • immunosuppressant
  • vascularized composite and reconstructive transplantation

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