Acharya Ratna, Clapp William, Upadhyay Kiran
Department of Pediatrics, Nemours Children's Hospital, Orlando, FL 32827, USA.
Division of Anatomic Pathology, Department of Pathology, University of Florida, Gainesville, FL 32610, USA.
Clin Pract. 2024 May 16;14(3):882-891. doi: 10.3390/clinpract14030069.
The inhibition of co-stimulation during T-cell activation has been shown to provide effective immunosuppression in kidney transplantation (KT). Hence, the conversion from calcineurin inhibitor (CNI) to belatacept is emerging as a potential alternate maintenance immunosuppressive therapy in those with transplant-associated thrombotic microangiopathy (TA-TMA) or in the prevention of TA-TMA. We present a 17-year-old male who presented with biopsy-proven CNI-associated TA-TMA immediately post-KT. The administration of eculizumab led to the reversal of TMA. Tacrolimus was converted to belatacept with excellent efficacy and safety during a short-term follow-up of one year. Further larger controlled studies are required to demonstrate the efficacy of this approach in children who present with early-onset TMA post-KT.
T细胞活化过程中共刺激的抑制已被证明在肾移植（KT）中可提供有效的免疫抑制作用。因此，对于患有移植相关血栓性微血管病（TA-TMA）的患者或预防TA-TMA，从钙调神经磷酸酶抑制剂（CNI）转换为贝拉西普正成为一种潜在的替代性维持免疫抑制疗法。我们报告一名17岁男性，在KT术后立即出现经活检证实的与CNI相关的TA-TMA。使用依库珠单抗治疗使TMA得到逆转。在为期一年的短期随访中，他克莫司转换为贝拉西普，疗效和安全性良好。需要进一步开展更大规模的对照研究，以证明这种方法对KT术后早发性TMA患儿的疗效。
