Successful conversion to belatacept after thrombotic microangiopathy in kidney transplant patients

Koppula, Sireesha; Yost, Sarah E.; Sussman, Amy; Bracamonte, Erika; Kaplan, Bruce

doi:10.1111/ctr.12170

Cited by 23 publications

(19 citation statements)

References 32 publications

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“…Although the use of belatacept is associated with an increased risk of aTCMR, it has been shown to be a good alternative in KTRs with a contraindication to CNIs. Multiple studies have reported successful conversion to belatacept in KTRs with CNI-induced nephrotoxicity, impaired allograft function, delayed graft function, CNI-mediated thrombotic microangiopathy, or atypical hemolytic uremic syndrome [65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82]. Furthermore, KTRs with poorly controlled diabetes mellitus while receiving CNI therapy may benefit from belatacept [83,84].…”

Section: Clinical Outcomes After Conversion To Belatacept In Kidney Tmentioning

confidence: 99%

Costimulation Blockade in Kidney Transplant Recipients

Zwan

Hesselink

Hoogen

et al. 2019

Drugs

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Costimulation between T cells and antigen-presenting cells is essential for the regulation of an effective alloimmune response and is not targeted with the conventional immunosuppressive therapy after kidney transplantation. Costimulation blockade therapy with biologicals allows precise targeting of the immune response but without non-immune adverse events. Multiple costimulation blockade approaches have been developed that inhibit the alloimmune response in kidney transplant recipients with varying degrees of success. Belatacept, an immunosuppressive drug that selectively targets the CD28-CD80/CD86 pathway, is the only costimulation blockade therapy that is currently approved for kidney transplant recipients. In the last decade, belatacept therapy has been shown to be a promising therapy in subgroups of kidney transplant recipients; however, the widespread use of belatacept has been tempered by an increased risk of acute kidney transplant rejection. The purpose of this review is to provide an overview of the costimulation blockade therapies that are currently in use or being developed for kidney transplant indications.

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Section: Clinical Outcomes After Conversion To Belatacept In Kidney Tmentioning

confidence: 99%

Costimulation Blockade in Kidney Transplant Recipients

Zwan

Hesselink

Hoogen

et al. 2019

Drugs

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“…Yapılan olgu sunumlarında, Belatacept'e dönüşüm yapılan olguların izleminde TMA' nın düzeldiği ve izlemde tekrar gelişmediği gözlenmiştir (32). Enfeksiyon gelişim riski açısından bakıldığında; Bassil ve ark.…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Neunclassified

Böbrek Naklinde Kullanılan Yeni İmmünsupresif İlaçlar

Güngör¹,

Alp²,

Pembegül³

et al. 2017

Turk Neph Dial Transpl

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ÖzSon dönem böbrek yetmezliğinin en seçkin tedavi yöntemi böbrek naklidir. Ne yazıkki akut-kronik rejeksiyonlar ve ilaç toksisiteleri nakil sonrası dönemde organ sağ kalımını kısaltmaktadır. Bu yüzden son yıllarda rejeksiyonları ve ilaç toksisitelerini azaltabilecek yeni ilaçların bulunması amaçlanmıştır. Biz bu derlemede son yıllarda böbrek naklinde kullanıma girmiş yeni immünsupresif ilaçların başlı-calarını özetlemeyi amaçladık. AnAhTAR sÖzcükleR: Böbrek nakli, Yeni, İmmünsupresif ilaçlar AbsTRAcTRenal transplantation is the most prominent treatment of end-stage renal failure. Unfortunately, acute and chronic rejections and drug toxicities reduce graft survival in the post-transplantation period. An attempt has therefore been made in recent years to develop new drugs that can reduce rejections and drug toxicities. In this review, we intended to summarize the new immunosuppressive drugs that have entered use in recent years. GİRİŞSon dönem böbrek yetmezliğinin en seçkin tedavi yöntemi böbrek naklidir. Başarılı bir böbrek nakli için, gerek indüksiyon, gerekse idame immünsupresif tedavinin hasta bazında bireyselleştirilmesi gerekir. Halen dünyada indüksiyon tedavisi için en sık Antitimosit globulin (ATG), idame tedavide ise kortikosteroid-kalsinörin inhibitörü-antimetabolit ilaç kombinasyonu tercih edilmektedir. Günümüzde halen akut hücresel ve humoral rejeksiyonlar ne yazıkki böbrek sağ kalımını olumsuz etkileyen önemli sorunlar olarak karşımıza çıkmaya devam etmektedir. bir yıllık graft sürveyi %90'ların üzerinde iken beş yıllık sürvey %72 civarındadır. Uzun süreli kullanımda ilaçların toksik etkilerinin ortaya çıkması son 10 yıl içerisinde böbrek naklinde indüksiyon ve idame tedavide farklı ajanların bulunması için bir gereklilik doğurmuştur. Özellikle böbrek nakli tedavisinin köşetaşı ilacı olan kalsinörin inhibitörlerinin iki yıldan uzun süre kullanımında yüksek oranda toksisite gelişimi bu ihtiyacı zorunlu hale getirmiştir. Biz bu yazıda böbrek nakli hastalarında son yıllarda deneme aşamasında olan ve/veya kullanılmaya başlanan yeni immünsupresif ilaçların genel özelliklerini ve böbrek naklindeki deneyimlerini sunmayı amaçladık. eculizumabEculizumab insanlaştırılmış bir monoklonal IgG2/4 antikordur. Kompleman C5 proteinine bağlanarak C5 konvertaz ile C5a ve C5b'ye yıkımını önleyerek membran atak kompleksi oluşumunu engeller ve kompleman aracılı hücre hasarına engel olur (1). Eculizumab temelde terminal kompleman kaskadını hedefler, ancak proksimal kompleman yolaklarının etkisini ortadan kaldıramayabilir.

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“…9,73 In the setting of renal transplant, substituting calcineurin inhibitors with belatacept, a selective costimulation blocker, has been shown to be successful in abating TMA in several cases and is recommended if it is safe to do so (high risk of posttransplant lymphoproliferative disorder in Epstein-Barr virusenegative recipients). 74 Many infections have been reported in conjunction with TMA. However, causal association is difficult to determine.…”

Section: Care Pathway 4 (Precipitating Factors)mentioning

confidence: 99%

Thrombotic Microangiopathy Care Pathway: A Consensus Statement for the Mayo Clinic Complement Alternative Pathway-Thrombotic Microangiopathy (CAP-TMA) Disease-Oriented Group

Winters

Leung

et al. 2016

Mayo Clinic Proceedings

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Thrombotic microangiopathies (TMAs) comprise a heterogeneous set of conditions linked by a common histopathologic finding of endothelial damage resulting in microvascular thromboses and potentially serious complications. The typical clinical presentation is microangiopathic hemolytic anemia accompanied by thrombocytopenia with varying degrees of organ ischemia. The differential diagnoses are generally broad, while the workup is frequently complex and can be confusing. This statement represents the joint recommendations from a multidisciplinary team of Mayo Clinic physicians specializing in the management of TMA. It comprises a series of evidence- and consensus-based clinical pathways developed to allow a uniform approach to the spectrum of care including when to suspect TMA, what differential diagnoses to consider, which diagnostic tests to order, and how to provide initial empiric therapy, as well as some guidance on subsequent management.

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Successful conversion to belatacept after thrombotic microangiopathy in kidney transplant patients

Cited by 23 publications

References 32 publications

Costimulation Blockade in Kidney Transplant Recipients

Costimulation Blockade in Kidney Transplant Recipients

Böbrek Naklinde Kullanılan Yeni İmmünsupresif İlaçlar

Thrombotic Microangiopathy Care Pathway: A Consensus Statement for the Mayo Clinic Complement Alternative Pathway-Thrombotic Microangiopathy (CAP-TMA) Disease-Oriented Group

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