{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T19:50:14Z","timestamp":1793994614448,"version":"4.8.0"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2013,1,1]],"date-time":"2013-01-01T00:00:00Z","timestamp":1356998400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Reports in Medicine"],"published-print":{"date-parts":[[2013]]},"abstract":"<jats:p>Thrombotic microangiopathy (TMA), a severe complication of renal transplantation, is a pathological process involving microvascular occlusion, thrombocytopenia, and microangiopathic hemolytic anemia. It generally appears within the first weeks after transplantation, when immunosuppressive drugs are used at high doses.<jats:italic>De novo<\/jats:italic>TMA may also be drug-induced when calcineurin inhibitors or proliferation signal inhibitors are used. We report three cases of<jats:italic>de novo<\/jats:italic>drug-induced TMA in renal transplant patients who were managed by replacing calcineurin inhibitors or proliferation signal inhibitors with belatacept, a primary maintenance immunosuppressive drug, which blocks the CD28 costimulation pathway, preventing the activation of T lymphocytes. To identify the cause of TMA, we ruled out HUS, hepatitis C serology, HIV serology, parvovirus B19, cytomegalovirus, anti-HLA antibodies, and prolonged activated partial thromboplastin time. We suspect that the TMA was caused by the calcineurin inhibitors or proliferation signal inhibitors. Belatacept treatment was initiated at a dose of 10\u2009mg\/kg on days 1, 5, 14, 28, 60, and 90; maintenance treatment was 5\u2009mg\/kg once a month for 1 year. Belatacept, in combination with other agents, prevented graft rejection in three patients.<\/jats:p>","DOI":"10.1155\/2013\/260254","type":"journal-article","created":{"date-parts":[[2013,10,1]],"date-time":"2013-10-01T17:00:58Z","timestamp":1380646858000},"page":"1-4","source":"Crossref","is-referenced-by-count":22,"title":["Use of Belatacept as Alternative Immunosuppression in Three Renal Transplant Patients with<i>De Novo<\/i>Drug-Induced Thrombotic Microangiopathy"],"prefix":"10.1155","volume":"2013","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8414-4823","authenticated-orcid":true,"given":"Federico","family":"Cicora","sequence":"first","affiliation":[{"name":"Renal Transplantation, Hospital Alem\u00e1n, Pueyrred\u00f3n 1640, C1118AAT Buenos Aires, Argentina"},{"name":"Foundation for Research and Assistance in Renal Disease (FINAER), Calle 503 No. 1947, CP B1897FYU, Gonnet, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Paz","sequence":"additional","affiliation":[{"name":"Renal Transplantation, Hospital Alem\u00e1n, Pueyrred\u00f3n 1640, C1118AAT Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6605-6459","authenticated-orcid":true,"given":"Fernando","family":"Mos","sequence":"additional","affiliation":[{"name":"Renal Transplantation, Hospital Alem\u00e1n, Pueyrred\u00f3n 1640, C1118AAT Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4285-5061","authenticated-orcid":true,"given":"Javier","family":"Roberti","sequence":"additional","affiliation":[{"name":"Foundation for Research and Assistance in Renal Disease (FINAER), Calle 503 No. 1947, CP B1897FYU, Gonnet, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra020528"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03156.x"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfs279"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03178.x"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.01184.x"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1046\/j.1600-6143.2003.00222.x"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03696.x"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-139X.2011.01035.x"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.01047.x"},{"issue":"1","key":"10","first-page":"27","volume":"33","year":"2013","journal-title":"Nefrologia"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2013.748747"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1586\/eci.12.79"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0030886"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2004.00428.x"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-6143.2003.00018.x"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03976.x"}],"container-title":["Case Reports in Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/crim\/2013\/260254.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crim\/2013\/260254.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crim\/2013\/260254.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2016,8,18]],"date-time":"2016-08-18T10:45:44Z","timestamp":1471517144000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.hindawi.com\/journals\/crim\/2013\/260254\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013]]},"references-count":16,"alternative-id":["260254","260254"],"URL":"https:\/\/doi.org\/10.1155\/2013\/260254","relation":{},"ISSN":["1687-9627","1687-9635"],"issn-type":[{"value":"1687-9627","type":"print"},{"value":"1687-9635","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013]]}}}