Conversion from tacrolimus to belatacept to prevent the progression of chronic kidney disease in pancreas transplantation: Case report of two patients

Muhammad Mujtaba, A. A. Sharfuddin, T. Taber, J. Chen, C. L. Phillips, M. Goble, J. A. Fridell

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2657-2661
Number of pages5
JournalAmerican Journal of Transplantation
Volume14
Issue number11
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Fingerprint

Pancreas Transplantation
Tacrolimus
Chronic Renal Insufficiency
Pancreas
Transplants
Kidney
Creatinine
Immunosuppression
Serum
Biopsy
Immunosuppressive Agents
Abatacept
Allografts
Disease Progression
Maintenance
Calcineurin Inhibitors

Keywords

  • clinical research/practice
  • immunosuppression/immune modulation
  • kidney transplantation/nephrology
  • off-label drug use
  • pancreas/simultaneous pancreas-kidney transplantation
  • patient safety

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Conversion from tacrolimus to belatacept to prevent the progression of chronic kidney disease in pancreas transplantation : Case report of two patients. / Mujtaba, Muhammad; Sharfuddin, A. A.; Taber, T.; Chen, J.; Phillips, C. L.; Goble, M.; Fridell, J. A.

In: American Journal of Transplantation, Vol. 14, No. 11, 01.11.2014, p. 2657-2661.

Research output: Contribution to journalArticle

Mujtaba, Muhammad ; Sharfuddin, A. A. ; Taber, T. ; Chen, J. ; Phillips, C. L. ; Goble, M. ; Fridell, J. A. / Conversion from tacrolimus to belatacept to prevent the progression of chronic kidney disease in pancreas transplantation : Case report of two patients. In: American Journal of Transplantation. 2014 ; Vol. 14, No. 11. pp. 2657-2661.
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