Does Belatacept Provide a Safe Renal Sparing Immunosuppression in Lung Transplant Recipients? A Single-Center Experience

Benn, L.; inger,; Chizinga, Mwelwa; Scheuble, V.; Nandavaram, Sravanthi; Shahmohammadi, Abbas; Pipkin, M.; Račkauskas, Mindaugas; Machuca, Tiago; Alnuaimat, Hassan; Lin, Christine M.; Emtiazjoo, A.; Peláez, Andrés; Chandrashekaran, S.

doi:10.1016/j.healun.2021.01.1930

Cited by 5 publications

(4 citation statements)

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“…From an infectious standpoint, Belatacept has been associated with an increased risk of developing viral, bacterial, and fungal infections [ [1] , [2] , [3] , [4] , 10 ]. There is limited evidence suggesting increased risk of EBV-positive post-transplant lymphoproliferative disorder (PTLD) when Belatacept is used in comparison to CNI [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years there has been an increase in use of Belatacept as a calcineurin inhibitor (CNI)- sparing immunosuppression regimen in lung transplantation, however, the efficacy and complications of this regimen is not well delineated. Reports suggest increased incidence of infections with Belatacept [ [1] , [2] , [3] , [4] ]. We present the case of progressive multifocal leukoencephalopathy (PML) associated with Belatacept use in a lung transplant recipient.…”

Section: Introductionmentioning

confidence: 99%

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A case report of a lung transplant recipient receiving belatacept in combination with low dose tacrolimus complicated by progressive multifocal leukoencephalopathy

et al. 2024

Respiratory Medicine Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A case report of a lung transplant recipient receiving belatacept in combination with low dose tacrolimus complicated by progressive multifocal leukoencephalopathy

et al. 2024

Respiratory Medicine Case Reports

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“…In a larger prospective cohort study of 85 lung recipients converted to belatacept from CNI within 1 year of transplant, Benninger et. al., reported no decline in graft function with stabilization of renal function [117]. Mycophenolate is an anti-metabolite that preferentially inhibits de novo purine synthesis in T-and B-lymphocytes, preventing their proliferation [110,112] In recent years mycophenolate has become the anti-metabolite of choice as it has demonstrated favorable effects in preventing ACR in other solid organ transplant, as well as beneficial effects in patients with existing CLAD [112].…”

Section: Immunosuppressive Therapymentioning

confidence: 99%

A Breath of Fresh Air - Lung Transplantation Has Come of Age

Keshavamurthy¹,

Russell²

2023

OBM Transplant

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A boundless spectrum of chronic lung diseases is said to effect over 500 million persons globally. Lung transplantation is a well-established therapeutic option for patients suffering from end-stage lung diseases, however waitlist mortality and primary graft failure remain major determinants as post-transplantation 5-year survival is just above 50 percent. Recent innovations in lung transplantation have been aimed at increasing organ availability, improving allograft quality, function, and longevity. Ex-vivo Lung Perfusion (EVLP) is an exciting modality responsible for multiple paths of lung allograft reconditioning as well as significantly extending preservation times. Mechanical circulatory support (MCS), specifically extracorporeal membrane oxygenation (ECMO) has consistently gained popularity not only for its use as a bridge to transplantation, but also its intraoperative role. In tandem, EVLP and ECMO have shown promising results in increasing the number of lung transplantations performed, therefore decreasing waitlist mortality. Primary graft dysfunction (PGD) and chronic lung allograft rejection (CLAD) continue to be the most feared predictors of poor outcomes. In this review we will highlight the historical progression of lung transplantation, its encumbrance, and the most recent advancements in promising techniques for long-term allograft protection and patient survival.

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“…In clinical trials of kidney transplant recipients, when used in lieu of CNI, Belatacept was associated with an increased risk of ACR [63], it has also been demonstrated to decrease the rate of development of donor-specific antibodies (DSAs) [61]. Unsurprisingly, there has been great interest in the utilization of this agent among LT recipients for its renal sparing effects, or for those intolerant of CNIs due to severe complications such as Posterior Reversible Encephalopathy Syndrome (PRES) or Thrombotic Thrombocytopenia Purpura (TTP) [64][65][66]. However, in the only RCT evaluating Belatacept among LT recipients, which randomized subjects to Belatacept plus reduced dose tacrolimus as part of a quadruple mIS strategy vs standard tacrolimus based triple mIS strategy, the trial was stopped after randomization of only 27 subjects due to an excess of deaths among the study arm (five vs none) [67].…”

Section: Optimizing Acr Riskmentioning

confidence: 99%

Acute Rejection of the Lung Allograft: Phenotypes and Management

Menachem,

Hanna,

Kulkarni

et al. 2023

OBM Transplant

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Treatment options for end stage lung diseases are limited to stabilizing lung failure, decreasing disease progression, and symptom management, but significant reversal of lost lung function is often not possible. For well selected patients, lung transplantation may be a viable option to improve both longevity and quality of life. Though outcomes for lung transplant recipients have improved over several decades, long term survival still lags behind that of other solid organ transplant recipients. Longevity after lung transplantation is limited by chronic lung allograft dysfunction. Numerous insults to the allograft contribute to chronic rejection, alloimmune injuries including acute T-cell mediated and antibody mediated rejection are chief among them. Therefore, monitoring for and management of acute cellular and antibody mediated rejection are of paramount importance to those caring for lung transplant recipients. We provide an up to date and comprehensive review of acute rejection affecting lung allografts and attempt to highlight pathophysiology, risk factors, clinical presentation, rejection phenotypes, management strategies, as well as related from of acute allograft injury.

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Does Belatacept Provide a Safe Renal Sparing Immunosuppression in Lung Transplant Recipients? A Single-Center Experience

Cited by 5 publications

References 0 publications

A case report of a lung transplant recipient receiving belatacept in combination with low dose tacrolimus complicated by progressive multifocal leukoencephalopathy

A case report of a lung transplant recipient receiving belatacept in combination with low dose tacrolimus complicated by progressive multifocal leukoencephalopathy

A Breath of Fresh Air - Lung Transplantation Has Come of Age

Acute Rejection of the Lung Allograft: Phenotypes and Management

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