Abstract: SA-PO1124
Five Concurrent Infections in a Kidney Transplant Recipient Receiving Belatacept
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Mahmoud, Saad Abdulrahim Talal, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Vanteru, Abinay Siva kumar Reddy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Israni, Avantika, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Introduction
Kidney transplant recipients are at increased risk for opportunistic infections due to chronic immunosuppression. Belatacept, a selective T-cell costimulation blocker, improves renal function and reduces calcineurin inhibitor toxicity but may alter infection risk. We report a rare case of simultaneous multipathogen infection following transition to belatacept
Case Description
A 39-year-old patient with ESRD due to lupus nephritis underwent deceased donor kidney transplantation (6/ 2024). Induction included ATG and steroids, followed by tacrolimus, MMF, and prednisone. On postoperative day 3, the patient developed thrombotic microangiopathy, prompting tacrolimus discontinuation and transition to cyclosporine.
One month later, biopsy for AKI showed borderline acute cellular rejection and acute tubular necrosis, treated with steroids. Persistent dysfunction led to repeat biopsy showing 25% IFTA without rejection. Cyclosporine was discontinued and belatacept initiated.
At six months, the patient presented with fever, diarrhea, and AKI; stool testing confirmed Norovirus infection. Labs revealed high ferritin (36,000 ng/mL), pancytopenia, and hypofibrinogenemia concerning for HLH. Echocardiogram showed reduced LVEF (25–30%). Infectious workup demonstrated Cytomegalovirus infection (1040 IU/mL), treated with ganciclovir, and blood cultures grew Pseudomonas aeruginosa infection. Further evaluation revealed disseminated Histoplasmosis confirmed by antigen testing and fungal cultures, treated with amphotericin B. HLH was attributed to histoplasmosis. Concurrent Epstein-Barr virus infection (14,400 IU/mL) prompted discontinuation of belatacept.
Following antimicrobial therapy and immunosuppression reduction, the patient improved and was transitioned back to cyclosporine. Kidney function stabilized (creatinine 3.0–3.3 mg/dL)
Discussion
This case represents a rare and unique report of a kidney transplant recipient on Belatacept developing five concurrent infections norovirus, CMV viremia, pseudomonas bacteremia, disseminated histoplasmosis, and EBV viremia. The clustering of multiple opportunistic and severe infections in a single patient highlights the profound immunomodulatory effects of belatacept, particularly in individuals with prior intensive immunosuppression. To our knowledge, this represents a uniquely complex case report demonstrating simultaneous multi-pathogen infection in the setting of belatacept