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Lack of efficacy and off label use: case report In a retrospective study involving 30 de novo kidney transplant recipients, a 39-year-old woman was described, who received offlabel treatment with belatacept. Additionally, she exhibited lack of efficacy during treatment with antithymocyte-globulin and unspecified steroids for pancreas graft rejection. The woman was receiving immunosuppression with unspecified regimens containing calcineurin inhibitor (CNI) following a combined pancreas and kidney transplant. Subsequently, her treatment was converted to off label IV belatacept 5 mg/kg on days 1, 15, 29, 43 and 57 for maintenance of immunosuppression. Thereafter, treatment was continued every 4 weeks. CNI dose was tapered in a modified way as follows: to 50% the day after conversion (day 2), to 25% on day 15 and 0 on day 29 and thereafter. Subsequently, she experienced a severe pancreas graft rejection. Hence, antithymocyte-globulin and steroids bolus was given. However, pancreas graft rejection was refractory to thymoglobulin and steroids bolus therapy and lead to graft loss at 4 months during follow up. Choi M, et al. Microvascular inflammation is a risk factor in kidney transplant recipients with very late conversion from calcineurin inhibitor-based regimens to belatacept. 803504886 BMC Nephrology 21: No. 1, 20 Aug 2020. Available from: URL: http://doi.org/10.1186/s12882-020-01992-6

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Reactions 3 Oct 2020 No. 1824