First Clinical Experience with Belatacept in 3 Hand Transplanted Patients.
1Viceral, Thoracic and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria
2Dermatology and Venerology, Innsbruck Medical University, Innsbruck, Austria
3Pathology, Innsbruck Medical University, Innsbruck, Austria
4Department of Blood Group Serology and Transfusion Medicine, Innsbruck Medical University, Innsbruck, Austria
5Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom.
Meeting: 2016 American Transplant Congress
Abstract number: 378
Keywords: Antibodies, Co-stimulation, Rejection
Session Information
Session Name: Concurrent Session: Clinical Vascularized Composite Allotransplantation
Session Type: Concurrent Session
Date: Tuesday, June 14, 2016
Session Time: 2:30pm-4:00pm
Presentation Time: 2:42pm-2:54pm
Location: Room 102
Study purpose
Belatacept (CTLA4Ig) is an emerging treatment in solid organ transplantation. Effects on the development of donor specific antibodies (DSA) as well as its clinical safety in challenging immunological settings have yet to be explored.
Methods
3 hand transplanted patients have been converted to a Belatacept-based immunosuppressive regimen at 4 months, 6 years and 9 years after unilateral or bilateral hand and forearm transplantation. Patients have received 5mg/kg Belatacept every 2 weeks, the dosing interval was then extended to 4 weeks after 5 applications. All 3 patients were kept on their baseline immunosuppressive medication, consisting of a CNI (Patients A, B, C) or mTOR inhibitor (Patients A and B) plus steroids (Patients A and B) and CellCept (Patient B).
Results
No adverse effects of Belatacept have been noted so far. Patient C, who received Belatacept 4 months after transplantation, can successfully be maintained on Tacrolimus monotherapy with a low trough level of ~5ng/ml. This patient has never developed donor-specific antibodies. Patient A, who had previously developed DSA but was in a stable immunological state at the time of conversion, is now successfully tapered from baseline immunosuppression without evidence of rejection. Patient B, who had DSA at the time of conversion, showed an increase of DSA and worsening graft appearance despite stable levels of his baseline immunosuppression and despite absence of a cellular infiltrate in the skin biopsy.
Discussion
The addition of Belatacept to an immunosuppressive regimen can be beneficial in hand transplantation. However, our patients showed variable results depending on the immunological state at the time of conversion. Based on our clinical experience, the application of Belatacept as a “rescue” medication has to be discussed critically.
CITATION INFORMATION: Grahammer J, Zelger B, Zelger B, Ninkovic M, Muehlbacher A, Oefner-Velano D, Schneeberger S, Weissenbacher A. First Clinical Experience with Belatacept in 3 Hand Transplanted Patients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Grahammer J, Zelger B, Zelger B, Ninkovic M, Muehlbacher A, Oefner-Velano D, Schneeberger S, Weissenbacher A. First Clinical Experience with Belatacept in 3 Hand Transplanted Patients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/first-clinical-experience-with-belatacept-in-3-hand-transplanted-patients/. Accessed May 11, 2025.« Back to 2016 American Transplant Congress