2555: Belatacept in hand transplantation - Effectiveness and pitfalls

Abstract

2555: Belatacept in hand transplantation Effectiveness and pitfalls Johanna Grahammer, MD, Bettina Zelger, MD, Bernhard Zelger, MD, Annelies Muehlbacher, MD, Dietmar Oefner, MD, Stefan Schneeberger, MD, and Annemarie Weissenbacher, MD Dept. of Visceral Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria; Oxford Transplant Center, Oxford, UK Study purpose Belatacept (CTLA4Ig) is an emerging treatment in solid organ transplantation Effects on the development of donor specific antibodies (DSA) as well as its clinical safety in challenging immunological settings have yet to be explored. Methods Three hand transplanted patients have been converted to a Belatacept-based immunosuppressive regimen at 4 months, 6 y and 9 y after unilateral or bilateral hand and forearm transplantation Patients have received 5 mg/kg Belatacept every 2 weeks, the dosing interval was then extended to 4 weeks after 5 applications All 3 patients were kept on their baseline immunosuppressive medication, consisting of a CNI (Patients A, B, C) or mTOR inhibitor (Patients A and B) plus steroids (Patients A and B) and CellCept (Patient B). Results No adverse effects of Belatacept have been noted so far Patient C, who received Belatacept 4 months after transplantation, can successfully be kept on Tacrolimus monotherapy with a low trough level of »4–5 ng/ml This patient has never developed donorspecific antibodies, and displays normal histologic findings Patient A, who had previously developed DSA but was in a stable immunological state at the time of conversion, is now successfully tapered from baseline immunosuppression without evidence of rejection Patient B, who had DSA at the time of conversion, showed an increase of DSA and worsening graft appearance despite stable levels of his baseline immunosuppression, and needed escalation of his immunosuppression. Discussion The addition of Belatacept to an immunosuppressive regimen can be beneficial in hand transplantation However, our patients showed variable results depending on the immunological state at the time of conversion The application of Belatacept as a “œrescue” medication has to be discussed critically. CONTACT Johanna Grahammer, MD johanna.grahammer@tirol-kliniken.at © 2016 Johanna Grahammer, Bettina Zelger, Bernhard Zelger, Annelies Muehlbacher, Dietmar Oefner, Stefan Schneeberger, and Annemarie Weissenbacher. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. VASCULARIZED COMPOSITE ALLOTRANSPLANTATION 2016, VOL. 3, NOS. 1–2, 27 http://dx.doi.org/10.1080/23723505.2016.1233009