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
{"title":"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。","authors":"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","doi":"10.1016/j.healun.2025.04.022","DOIUrl":null,"url":null,"abstract":"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.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"39 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Belatacept as an Alternative Immunosuppressive Agent for Bone Marrow-Sparing in Idiopathic Pulmonary Fibrosis Lung Transplant Recipients with Short Telomeres.\",\"authors\":\"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\",\"doi\":\"10.1016/j.healun.2025.04.022\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"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.\",\"PeriodicalId\":22654,\"journal\":{\"name\":\"The Journal of Heart and Lung Transplantation\",\"volume\":\"39 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-05-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Journal of Heart and Lung Transplantation\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.healun.2025.04.022\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of Heart and Lung Transplantation","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.healun.2025.04.022","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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.