作为特发性肺纤维化短端粒肺移植受者骨髓保留的替代免疫抑制剂。

Stefanie J Hannan,Carlo J Iasella,Michel Sciullo,Cody Moore,Ryan Rivosecci,Lauren Sacha,Rachel M Sutton,Ritchie Koshy,Norihisa Shigemura,Pablo G Sanchez,Rafic Farah,Chadi A Hage,Jonathan K Alder,John F McDyer
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引用次数: 0

摘要

正如我们之前所显示的,端粒长度短(STL)的特发性肺纤维化肺移植受者(ipf - lts)在移植后容易出现明显的细胞减少和对细胞周期抑制剂(特别是霉酚酸酯(MMF))的耐受性差。我们调查了Belatacept作为一种替代免疫抑制剂在我们机构的9个st - ipf - ltr的前瞻性开放标签队列中的使用情况。这些患者要么接受MMF挑战(大多数),要么在移植后立即开始使用Belatacept,目的是与移植后常用的mTOR抑制剂依维莫司(Everolimus)建立桥梁。我们描述了移植后第一年的结果,包括急性细胞排斥反应(ACR)、eb病毒(EBV)病毒血症的发生率,以及一例移植后13个月的淋巴细胞增生性疾病(PTLD)。对于伴有细胞减少的st- ipf - ltr患者,肺移植后使用Belatacept可能是一种可接受的短期替代细胞周期抑制剂治疗,但当这些患者长期使用Belatacept时,可能导致EBV病毒血症和PTLD的风险更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Belatacept as an Alternative Immunosuppressive Agent for Bone Marrow-Sparing in Idiopathic Pulmonary Fibrosis Lung Transplant Recipients with Short Telomeres.
As we have previously shown, Idiopathic pulmonary fibrosis lung transplant recipients (IPF-LTRs) with short-telomere length (STL) are prone to develop significant cytopenias and poor tolerance to cell cycle inhibitors, specifically Mycophenolate mofetil (MMF), post-transplant. We investigated the use of Belatacept as an alternative immunosuppressive agent in a prospective, open-label cohort of 9 ST-IPF-LTRs at our institution. These patients were either challenged with MMF (majority) or immediately started on Belatacept post-transplant with the goal to bridge to Everolimus, an mTOR inhibitor that is commonly used post-transplant. We describe outcomes in the first-year post-transplant including the incidence of Acute Cellular Rejection (ACR), Epstein-Barr Virus (EBV) viremia, and one case of Post-Transplant Lymphoproliferative Disorder (PTLD) at 13 months. The use of Belatacept post-lung transplant may be an acceptable short-term alternative therapy to cell cycle inhibitors in ST-IPF-LTRs with cytopenias but may lead to higher risk of EBV viremia and PTLD when Belatacept is used long-term in these patients.
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