{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:04:55Z","timestamp":1789621495700,"version":"build-2803163510"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Renal allograft dysfunction after simultaneous heart-kidney transplantation (SHKT) is often multifactorial, reflecting perioperative hemodynamic instability, ischemia-reperfusion injury, alloimmune activation, and calcineurin inhibitor exposure. The therapeutic role of belatacept in this dual-organ setting remains poorly defined. We report the case of a 47-year-old woman with systemic lupus erythematosus, antiphospholipid syndrome, previous kidney allograft loss and heart failure, who underwent SHKT. The post-transplant course was complicated by persistent anuria requiring prolonged dialysis dependence, a high-titer\n                    <jats:italic>de novo<\/jats:italic>\n                    class II donor-specific antibody (DSA), and biopsy-proven cardiac antibody-mediated and cellular rejection. Despite intensive anti-rejection treatment, cardiac histology improved and DSA levels decreased, but renal allograft function did not recover. Belatacept was introduced at post-transplant week 12 with tacrolimus minimization. Thereafter, diuresis progressively resumed and dialysis was discontinued, with progressive improvement in renal function, while DSA became progressively undetectable. At 6 months, both grafts are functioning, serum creatinine is 1.4 mg\/dL and no DSA rebound occurred. This case highlights the potential role of belatacept-based immunosuppression in the complex setting of SHKT with prolonged kidney allograft dysfunction.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1907833","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:47:42Z","timestamp":1789620462000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Kidney allograft recovery after conversion to belatacept-based immunosuppression in simultaneous heart\u2013kidney transplantation"],"prefix":"10.3389","volume":"17","author":[{"given":"Elisa","family":"Gessaroli","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Sabatino","sequence":"additional","affiliation":[{"name":"Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelodaniele","family":"Napoletano","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilika","family":"Samara","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Vetrano","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma 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Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Comai","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna","place":["Bologna, Italy"]},{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Potena","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna","place":["Bologna, Italy"]},{"name":"Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Corradetti","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda 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