Most immunosuppressive regimens in vascularized composite allotransplantation (VCA) have been calcineurin inhibitor (CNI)–based. Costimulation blockade has emerged as a replacement for CNI–based regimens in kidney transplantation. We have previously shown that belatacept can be used as a centerpiece immunosuppressant for VCA in non-human primates, and subsequently reported successful conversion from a CNI–based regimen to a belatacept–based regimen after hand transplantation.The goal of this study was to develop a regimen using de-novo belatacept minimizing chronic exposure to CNIs. We now report on a hand transplant recipient, who we have successfully treated with a de novo belatacept–based regimen, transitioned to a CNI–free regimen. The recipient was a 54-year-old man who had a hand amputation at 4 years-old. The patient received induction with RATG. At postoperative month (POM) 4 the patient experienced an increase of serum creatinine of 1.3 mg/dL that resolved with a reduction in the tacrolimus dose. One rejection episode Banff III was diagnosed at POM 8 that was successfully reversed with steroids.Currently,the patient is 20 months-post-transplant on belatacept, MMF, and prednisone. His serum creatinine is 1.0 mg/dl .No alloantibody formation has been observed.The last skin biopsy was Banff 0.The patient reports performing activities such as fishing and riding his motorcycle.This case demonstrates that de novo belatacept can provide sufficient prophylaxis from rejection without chronic CNI–associated side effects in clinical VCA, a particularly important goal in non-lifesaving solid organ transplants such as VCA.

CITATION INFORMATION: Cendales L. C., Ruch D. S., Cardones A. R., Potter G., Dooley J., Dore D., Orr J., Ruskin G., Song M., Chen D., Selim A., Kirk A. D. De Novo Belatacept in Clinical Vascularized Composite Allotransplantation Am J Transplant. 2017;17 (suppl 3).

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