Belatacept CNI-Free Regimen — ESENeph MCQ

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HardTransplantationBelatacept CNI-Free RegimenESENeph

A transplant recipient develops Tacrolimus-associated posterior reversible encephalopathy syndrome (PRES). Tacrolimus is stopped. What CNI-free immunosuppressive regimen can be considered to avoid recurrence?

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Correct answer: E — Belatacept-based immunosuppression

Belatacept is a selective T-cell co-stimulation blocker (CTLA4-Ig) that provides CNI-free immunosuppression. It is indicated when CNIs are contraindicated or poorly tolerated (e.g. PRES, severe CNI nephrotoxicity). The BENEFIT trial showed non-inferior graft survival with better renal function. Ciclosporin is another CNI and carries the same PRES risk. Sirolimus (mTOR inhibitor) can be used but not as monotherapy. Belatacept requires the patient to be EBV-seropositive (risk of PTLD in seronegative recipients).

Reference: KDIGO 2009 – Transplant; BENEFIT Trial – NEJM 2016