Hui Christine, Kern Ryan, Wojciechowski David, Kukreja Jasleen, Golden Jeffrey A, Hays Steven R, Singer Jonathan P
UCSF Medical Center, San Francisco, CA, USA.
J Investig Med High Impact Case Rep. 2014 Sep 22;2(3):2324709614546866. doi: 10.1177/2324709614546866. eCollection 2014 Jul-Sep.
Belatacept is a novel immunosuppressant that blocks a T-cell costimulation pathway and is approved for use in adult kidney transplant recipients. Its safety and efficacy have not been established after lung transplantation. We present a case of a lung transplant recipient treated with belatacept. A 56-year-old man underwent bilateral lung retransplantation for bronchiolitis obliterans syndrome (BOS). In the third year posttransplant, he developed hemolytic uremic syndrome (HUS) attributed to tacrolimus. Tacrolimus was changed to sirolimus. One month later, he presented with worsening renal function and HUS attributed to sirolimus. Plasmapheresis and steroid pulse were initiated with clinical improvement, and sirolimus was switched to belatacept. He experienced no episodes of cellular rejection but developed recurrent BOS. Complications during treatment included anemia and recurrent pneumonias. The safety and efficacy of belatacept in lung transplantation remains unclear; further studies are needed.
贝拉西普是一种新型免疫抑制剂，可阻断T细胞共刺激途径，已被批准用于成年肾移植受者。肺移植后其安全性和有效性尚未确立。我们报告一例接受贝拉西普治疗的肺移植受者。一名56岁男性因闭塞性细支气管炎综合征（BOS）接受了双侧肺再次移植。移植后第三年，他因他克莫司出现了溶血性尿毒症综合征（HUS）。他克莫司更换为西罗莫司。一个月后，他因西罗莫司出现肾功能恶化和HUS。开始进行血浆置换和类固醇冲击治疗，临床症状改善，西罗莫司更换为贝拉西普。他没有发生细胞排斥反应，但出现了复发性BOS。治疗期间的并发症包括贫血和复发性肺炎。贝拉西普在肺移植中的安全性和有效性仍不清楚；需要进一步研究。
