Gani Imran, Mirza Ahmad, Baig Usman
Department of Nephrology, Hypertension and Transplant Medicine, Wellstar MCG Health, Augusta University, Augusta, GA 30912, USA.
Transplant Surgery Division, Wellstar MCG Health, Augusta University, Augusta, GA 30912, USA.
Viruses. 2025 Apr 23;17(5):595. doi: 10.3390/v17050595.
Belatacept is a recombinant fusion protein used in renal transplant recipients, particularly when side effects from standard immunosuppressants occur. It offers a superior renal safety profile and is associated with better long-term renal graft outcomes. However, belatacept has been linked to atypical presentations of cytomegalovirus (CMV) infections, characterized by a prolonged and unpredictable course of viremia. We report a case involving a middle-aged African American female who developed acute kidney injury while on tacrolimus and was subsequently switched to belatacept. During treatment with belatacept, she experienced persistent and erratic CMV viremia lasting 58 weeks. The viremia showed an incomplete response to first-line antiviral therapy with valganciclovir, and the use of the novel antiviral agent maribavir also failed to achieve long-lasting viremic clearance. The resolution of the viremia was ultimately achieved only after discontinuing belatacept while continuing maribavir therapy. This case and literature review underscores the need for clinicians to remain vigilant for atypical CMV infections in renal transplant recipients treated with belatacept. If the complete clearance of viremia cannot be achieved despite the use of different antiviral agents, consideration should be given to modifying immunosuppressive therapy.
贝拉西普是一种重组融合蛋白，用于肾移植受者，特别是在出现标准免疫抑制剂的副作用时。它具有更好的肾脏安全性，并且与更好的长期肾移植结果相关。然而，贝拉西普与巨细胞病毒（CMV）感染的非典型表现有关，其特征为病毒血症病程延长且不可预测。我们报告了一例病例，一名中年非裔美国女性在使用他克莫司期间发生急性肾损伤，随后改用贝拉西普。在使用贝拉西普治疗期间，她经历了持续且不稳定的CMV病毒血症，持续了58周。病毒血症对一线抗病毒药物缬更昔洛韦治疗反应不完全，新型抗病毒药物马立巴韦的使用也未能实现持久的病毒血症清除。仅在停用贝拉西普并继续使用马立巴韦治疗后，病毒血症最终才得以消退。该病例及文献综述强调，临床医生在使用贝拉西普治疗的肾移植受者中，需要对非典型CMV感染保持警惕。如果尽管使用了不同的抗病毒药物仍无法实现病毒血症的完全清除，则应考虑调整免疫抑制治疗。
