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Severe Acute Cellular Rejection With High-Grade Lymphocytic Bronchiolitis Following Transition from Tacrolimus to Belatacept in a Lung Transplantation Recipient: A Case Report
Affiliation:1. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA;2. Advanced Lung Disease and Lung Transplantation, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA;3. Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA;1. Pneumology Department, University Hospital Center, Poitiers, France;2. Pneumology Department, University Hospital Center, Rennes, France;1. Department of Women''s Health, Waikato Hospital, Pembroke Street, Hamilton 3204, New Zealand;2. Department of Pathology, Waikato Hospital, Pembroke Street, Hamilton 3204, New Zealand;1. Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio;2. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio;3. Independent consultant, East Providence, Rhode Island;1. Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan;2. Gastroenterological Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan;3. Department of Otolaryngology, Graduate School of Medicine, Osaka City University, Osaka, Japan
Abstract:This case report describes a lung transplantation recipient who developed severe acute cellular rejection with high-grade lymphocytic bronchiolitis after transition to a calcineurin-free regimen using belatacept. A 53-year-old man who had undergone lung transplantation 3 years prior developed progressive chronic kidney disease related to tacrolimus. He was transitioned off tacrolimus to belatacept to prevent the need for dialysis. He was admitted 2 months later with acute hypoxemic respiratory failure. Video-assisted thoracic surgery biopsy showed acute fibrinous and organizing pneumonia and A4B2 rejection. He subsequently developed chronic lung allograft dysfunction. This case illustrates the potential increased risk of acute rejection associated with belatacept maintenance immunosuppression.
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