Conversion From Tacrolimus to Belatacept to Prevent the Progression of Chronic Kidney Disease in Pancreas Transplantation: Case Report of Two Patients

• Published in: American journal of transplantation Vol. 14; no. 11; pp. 2657 - 2661
• Main Authors: Mujtaba, M. A., Sharfuddin, A. A., Taber, T., Chen, J., Phillips, C. L., Goble, M., Fridell, J. A.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley 01.11.2014; Elsevier Limited
• Subjects: Abatacept; Adult; Biological and medical sciences; clinical research/practice; Disease Progression; Female; Humans; Immunoconjugates - administration & dosage; immunosuppression/immune modulation; Immunosuppressive Agents - administration & dosage; Kidney Failure, Chronic - physiopathology; kidney transplantation/nephrology; Kidneys; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; off‐label drug use; Pancreas Transplantation - adverse effects; pancreas/simultaneous pancreas–kidney transplantation; patient safety; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - administration & dosage; Urinary system involvement in other diseases. Miscellaneous; Calcineurin inhibitor; Prognosis; Belatacept; Transplantation; Homotransplantation; Prevention; Surgery; Graft; Evolution; Protein synthesis inhibitor; Fusion protein; Pancreas; Kidney disease; Human; Urinary system disease; Lactone; Chronic kidney disease; Macrolide; Conversion; Case study; Immunomodulator; Drug conversion; Treatment; Tacrolimus; Renal failure; Immunosuppressive agent; Antibacterial agent; pancreas/simultaneous pancreas-kidney transplantation; patient safety; off-label drug use; immunosuppression/immune modulation; clinical research/practice; kidney transplantation/nephrology
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.12863

Belatacept is a novel immunosuppressive agent that may be used as an alternative to calcineurin inhibitors (CNI) in immunosuppression (IS) regimens. We report two cases of pancreas transplant that were switched from tacrolimus (TAC) to belatacept. Case 1: 38‐year‐old female with pancreas transplant alone maintained on TAC‐based IS regimen whose serum creatinine (SCr) slowly deteriorated from 0.6 mg/dL at baseline to 2.2 mg/dL, 16 months posttransplant. A native kidney biopsy performed showed CNI toxicity. The patient was started on belatacept and TAC was eliminated. Case 2: 49‐year‐old female with simultaneous pancreas–kidney transplant, maintained on TAC‐based regimen where the SCr worsened over an initial 3‐month period from a baseline of 1.0 to 3.0 mg/dL. Belatacept was started and TAC was lowered. Due to persistent graft dysfunction and kidney transplant biopsy still showing changes consistent with CNI toxicity, the TAC was then discontinued. At >1 year postbelatacept and off TAC follow‐up, kidney function as measured by SCr remains stable at 1.0 ± 0.2 mg/dL in both recipients. Neither patient developed rejection following the switch, and pancreas allograft function remains stable in both recipients. The authors describe two cases of pancreas transplant recipients whose calcineurin inhibitor maintenance regimen was converted to belatacept to avoid chronic kidney disease progression, which allowed these patients to be maintained pancreas rejection–free on belatacept therapy, while maintaining excellent renal function.