Heldman Madeleine R, Saullo Jennifer L, Menachem Brandon M, Messina Julia A, Arif Sana, Steinbrink Julie M, Tam Patrick C K, Carugati Manuela, Wolfe Cameron R, Baker Arthur W, Maziarz Eileen K
Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Transpl Infect Dis. 2025 Jan-Feb;27(1):e14403. doi: 10.1111/tid.14403. Epub 2024 Nov 4.
Belatacept is a costimulatory blocker that can be used to prevent and treat rejection in lung transplant recipients (LuTRs). The epidemiology of infections in belatacept-treated LuTRs has not been systematically evaluated.
We performed a single-center retrospective study of all adult LuTRs who received belatacept as prevention or treatment of antibody-mediated rejection (desensitization) or as part of maintenance immunosuppression from January 1, 2011, to June 30, 2022. We assessed the epidemiology of infections that occurred within 12 months following the first belatacept dose.
Fifty-two LuTRs received at least one dose of belatacept as either desensitization (n = 32) or maintenance immunosuppression (n = 20). Among 45 patients who were cytomegalovirus (CMV) donor and/or recipient seropositive, nine (20%) developed CMV infection. Seven (77%) CMV infections occurred despite valganciclovir prophylaxis and four (44%) were associated with antiviral resistance. Three (6%) LuTRs developed Epstein-Barr virus (EBV) associated post-transplant lymphoproliferative disorder (PTLD). Twenty-five (48%) LuTRs developed 43 bacterial infections and five (10%) developed proven or probable invasive fungal disease. Incidence rates of viral, bacterial, and fungal infections were similar between the desensitization and maintenance groups: incidence rate ratios (95% confidence interval) were 0.70 (0.32-1.57), 1.31 (0.70-2.46), and 2.82 (0.31-25.2), respectively. Infection/PTLD prompted belatacept discontinuation in eight (15%) patients.
In the first year after belatacept initiation, LuTRs commonly developed CMV infections, EBV+ PTLD, and bacterial infections. Multicenter collaborations are needed to better understand infection risks in LuTRs treated with belatacept.
贝拉西普是一种共刺激阻滞剂，可用于预防和治疗肺移植受者（LuTRs）的排斥反应。贝拉西普治疗的LuTRs感染的流行病学尚未得到系统评估。
我们对2011年1月1日至2022年6月30日期间接受贝拉西普预防或治疗抗体介导的排斥反应（脱敏）或作为维持免疫抑制一部分的所有成年LuTRs进行了单中心回顾性研究。我们评估了首次使用贝拉西普剂量后12个月内发生的感染的流行病学情况。
52例LuTRs接受了至少一剂贝拉西普，用于脱敏（n = 32）或维持免疫抑制（n = 20）。在45例巨细胞病毒（CMV）供体和/或受体血清学阳性的患者中，9例（20%）发生了CMV感染。尽管使用了缬更昔洛韦预防，仍有7例（77%）发生了CMV感染，4例（44%）与抗病毒耐药有关。3例（6%）LuTRs发生了与 Epstein-Barr病毒（EBV）相关的移植后淋巴细胞增生性疾病（PTLD）。25例（48%）LuTRs发生了43次细菌感染，5例（10%）发生了确诊或可能的侵袭性真菌病。脱敏组和维持组之间病毒、细菌和真菌感染的发生率相似：发生率比值（95%置信区间）分别为0.70（0.32 - 1.57）、1.31（0.70 - 2.46）和2.82（0.31 - 25.2）。感染/PTLD促使8例（15%）患者停用贝拉西普。
在开始使用贝拉西普后的第一年，LuTRs常见CMV感染、EBV + PTLD和细菌感染。需要多中心合作以更好地了解接受贝拉西普治疗的LuTRs的感染风险。
