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Use of belatacept to maintain adequate early immunosuppression in calcineurin-mediated microangiopathic hemolysis post-renal transplant

Lookup NU author(s): David Talbot

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Abstract

We report a 17-yr-old boy who developed a microangiopathic hemolytic anemia presumed secondary to tacrolimus shortly following a living-related donor renal transplant. This was initially managed by plasmapheresis. Reinstitution of calcineurin inhibition using cyclosporine led to recurrence of hemolysis, so an alternative agent was needed. He was commenced on monthly intravenous belatacept, with no further recurrence of the hemolysis, and subsequent stable graft function. Modulation via CTLA-4 offers an alternative immunosuppressive tactic if current regimens produce graft threatening adverse effects. The method of administration and frequency of dosage of belatacept also lends itself well to the high-risk period of adolescence and transition. We propose that belatacept may therefore also have utility in difficult cases complicated by poor concordance, common in the adolescent age group.

Publication metadata

Author(s): Reynolds BC, Talbot D, Baines L, Brown A

Publication type: Article

Publication status: Published

Journal: Pediatric Transplantation

Year: 2014

Volume: 18

Issue: 5

Pages: E140-E145

Print publication date: 01/08/2014

Online publication date: 12/05/2014

ISSN (print): 1397-3142

ISSN (electronic): 1399-3046

Publisher: Wiley-Blackwell Publishing, Inc.

URL: http://dx.doi.org/10.1111/petr.12278

DOI: 10.1111/petr.12278

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