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Author Notes:

Corresponding author: Linda Cendales, Email: Linda.Cendales@duke.edu


Research Funding:

This study was supported by The National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454, a grant from the Department of Defense administered through the Navy Bureau of Medicine and Surgery's Medical Development Program, and by resources at the Atlanta VA Medical Center.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery
  • Transplantation

Tacrolimus to Belatacept Conversion Following Hand Transplantation: A Case Report

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Journal Title:

American Journal of Transplantation


Volume 15, Number 8


, Pages 2250-2255

Type of Work:

Article | Post-print: After Peer Review


Vascularized composite allotransplantation (VCA) has emerged as a viable limb replacement strategy for selected patients with upper limb amputation. However, allograft rejection has been seen in essentially all reported VCA recipients indicating a requirement for substantial immunosuppressive therapy. Calcineurin inhibitors have served as the centerpiece agent in all reported cases, and CNI-associated complications associated with the broad therapeutic effects and side effects of calcineurin inhibitors have been similarly common. Recently, belatacept has been approved as a calcineurin inhibitor replacement in kidney transplantation, but to date, its use in VCA has not been reported. Herein, we report on the case of a hand transplant recipient who developed recurrent acute rejection with alloantibody formation and concomitant calcineurin inhibitor nephrotoxicity, all of which resolved upon conversion from a maintenance regimen of tacrolimus, mycophenolate mofetil and steroids to belatacept and sirolimus. This case indicates that belatacept may be a reasonable maintenance immunosuppressive alternative for use in VCA, providing sufficient prophylaxis from rejection with a reduced side effect profile, the latter being particularly relevant for nonlife threatening conditions typically treated by VCA.

Copyright information:

© 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

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