| Affiliation: | 1. Department of Surgery, Duke University School of Medicine, Durham, NC, USA;2. Department of Orthopaedics, Duke University School of Medicine, Durham, NC, USA;3. Department of Dermatology, Duke University School of Medicine, Durham, NC, USA;4. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA;5. Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA;6. Department of Physical Therapy and Occupational Therapy, Duke University Hospital, Durham, NC, USA;7. Department of Pathology, Duke University School of Medicine, Durham, NC, USA |
| Abstract: | Most immunosuppressive regimens used in clinical vascularized composite allotransplantation (VCA) have been calcineurin inhibitor (CNI)‐based. As such, most recipients have experienced CNI‐related side effects. Costimulation blockade, specifically CD28/B7 inhibition with belatacept, has emerged as a clinical replacement for CNI‐based immunosuppression in kidney transplantation. We have previously shown that belatacept can be used as a centerpiece immunosuppressant for VCA in nonhuman primates, and subsequently reported successful conversion from a CNI‐based regimen to a belatacept‐based regimen after clinical hand transplantation. We now report on the case of a hand transplant recipient, whom we have successfully treated with a de novo belatacept‐based regimen, transitioned to a CNI–free regimen. This case demonstrates that belatacept can provide sufficient prophylaxis from rejection without chronic CNI‐associated side effects, a particularly important goal in nonlifesaving solid organ transplants such as VCA. |
