Belatacept Maintenance in a Heart Transplant Recipient

Enderby, Cher Y.; Habib, Phillip; Patel, Parag C.; Yip, Daniel; Orum, Stephanie; Hosenpud, Jeffrey D.

doi:10.1097/tp.0000000000000404

Cited by 24 publications

(14 citation statements)

References 5 publications

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“…11 However, the patient died in a context of cardiac arrest 7 months after initiation of BTC and no autopsy was performed. Only 2 case reports of the use of BTC in heart transplant recipients have been published.…”

Section: Discussionmentioning

confidence: 99%

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Belatacept-based immunosuppression: A calcineurin inhibitor-sparing regimen in heart transplant recipients

Launay

Guitard

Dorent

et al. 2020

American Journal of Transplantation

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| INTRODUC TI ONCalcineurin inhibitors (CNI) are the backbone of immunosuppression in solid organ transplantation, but long-term exposure is often associated with nephrotoxicity. 1 Belatacept (BTC) (Nulojix ® ) is a highaffinity CTLA4Ig indicated for the prophylaxis of graft rejection in adults receiving a renal transplant in combination with mycophenolic acid (MPA) and corticosteroids. 2,3 The BENEFIT study demonstrated that BTC-based regimens were associated with a similar incidence of acute rejection but improved renal function compared to a cyclosporine-based regimen in renal transplant recipients. 4 The BENEFIT and BENEFIT-EXT studies showed that the risk of posttransplant

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Section: Discussionmentioning

confidence: 99%

“…pression with no episodes of rejection. 11 However, the patient died in a context of cardiac arrest 7 months after initiation of BTC and no autopsy was performed. BTC use was also described in another woman with heart-liver transplantation followed by kidney transplantation.…”

Section: Immunosuppressive Therapy After Btc Discontinuationmentioning

confidence: 99%

Belatacept-based immunosuppression: A calcineurin inhibitor-sparing regimen in heart transplant recipients

Launay

Guitard

Dorent

et al. 2020

American Journal of Transplantation

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“…There was 1 episode of graft rejection on belatacept therapy in a patient who had also had early rejection before initiation of belatacept. Other than an isolated case report, 56 there have been no reports in the use of belatacept in heart transplant recipients. Review of the clinical trials registry (www.clinicaltrials.gov,accessed online 11/23/14) reveals 39 belatacept studies in transplantation of which 34 focus on kidney transplant, 4 on pancreas or islet and 1 liver (described above).…”

Section: Belataceptmentioning

confidence: 97%

Acute Kidney Disease After Liver and Heart Transplantation

Rossi

Vella²

2016

Transplantation

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After transplantation of nonrenal solid organs, an acute decline in kidney function develops in the majority of patients. In addition, a significant number of nonrenal solid organ transplant recipients develop chronic kidney disease, and some develop end-stage renal disease, requiring renal replacement therapy. The incidence varies depending on the transplanted organ. Acute kidney injury after nonrenal solid organ transplantation is associated with prolonged length of stay, cost, increased risk of death, de novo chronic kidney disease, and end-stage renal disease. This overview focuses on the risk factors for posttransplant acute kidney injury after liver and heart transplantation, integrating discussion of proteinuria and chronic kidney disease with emphasis on pathogenesis, histopathology, and management including the use of mechanistic target of rapamycin inhibition and costimulatory blockade.

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“…While on belatacept, surveillance biopsies revealed no new episodes of rejection; coronary angiogram revealed normal coronaries and echocardiography revealed a left ventricular ejection fraction of 61%. The patient died from cardiac arrest 6 months after addition of belatacept due to unclear reasons (49). …”

Section: Aims and Methodsmentioning

confidence: 99%

Belatacept As an Alternative to Calcineurin Inhibitors in Patients with Solid Organ Transplants

Kumar¹,

LeCorchick²,

Gupta³

2017

Front. Med.

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The goal of immunosuppression in transplantation has shifted to improving long-term outcomes, reducing drug-induced toxicities while preserving the already excellent short-term outcomes. Long-term gains in solid organ transplantation have been limited at least partly due to the nephrotoxicity and metabolic side effects of calcineurin inhibitors (CNIs). The alloimmune response requires activation of the costimulatory pathway for T cell proliferation and amplification. Belatacept is a molecule that selectively blocks T cell costimulation. In June 2011, the U.S. Food and Drug Administration approved it for maintenance immunosuppression in kidney transplantation based on two open-label, randomized, phase III trials. Since its introduction, belatacept has shown promise in both short- and long-term renal transplant outcomes in several other trials. It exhibits a superior side effect profile compared to CNIs with a comparable efficacy. Across all solid organ transplants, the burden of chronic kidney disease, its associated cardiovascular morbidity, mortality, and inferior patient/allograft survival is a well-documented problem. In this review, we aim to discuss the evidence behind the use of belatacept in solid organ transplants as an effective alternative to CNIs for renal rescue in patients with acute and/or chronic kidney injury.

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Belatacept Maintenance in a Heart Transplant Recipient

Cited by 24 publications

References 5 publications

Belatacept-based immunosuppression: A calcineurin inhibitor-sparing regimen in heart transplant recipients

Belatacept-based immunosuppression: A calcineurin inhibitor-sparing regimen in heart transplant recipients

Acute Kidney Disease After Liver and Heart Transplantation

Belatacept As an Alternative to Calcineurin Inhibitors in Patients with Solid Organ Transplants

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