Post-transplant course. (a) Case 1 underwent heart/liver transplant (DSA=3, class I). Uncomplicated post-transplant course with no rejection and no DSA at last follow-up. (b) Case 2 underwent heart transplant (DSA=6, class II). Belatacept continued post-transplant. DSA (4/6) suppressed. Graft dysfunction (grade 1R/1B ACR, no AMR) in the setting of medication nonadherence. Treated with IV corticosteroids and thymoglobulin. Developed several viral infections. LVEF improved to 50% and the remaining 2/6 DSA have MFI< 5000 at last follow-up. (c) Case 3 underwent heart transplant (DSA=8, class I and II). Belatacept was continued post-transplant. All 8 DSA suppressed. Mild (grade 1R/1B) ACR treated with outpatient oral prednisone pulse (normal graft function, no AMR). Mild cardiac allograft vasculopathy on 6-month surveillance angiography. Graft function remains normal (>55%).
ACR, acute cellular rejection; AMR, antibody mediated rejection.