Late onset Pneumocystis pneumonia in renal transplantation after long-term immunosuppression with belatacept

Transpl Infect Dis. 2009 Apr;11(2):171-4. doi: 10.1111/j.1399-3062.2009.00366.x. Epub 2009 Feb 5.


Interference with T-cell function increases the risk of infections, especially during the early post-transplant period. Belatacept, a costimulation blocker, is currently being tested in phase III clinical trials. Here we report a renal transplant recipient who received belatacept and developed severe Pneumocystis jirovecii pneumonia (PCP) with fatal superinfections 4 years post transplant. Cytomegalovirus infection preceded PCP, which typically occurs in overimmunosuppressed patients, but has not yet been reported under T-cell costimulation blockade in transplant patients. This case illustrates the possibility of excessive immunosuppression even with a lymphocyte-specific regimen.

Publication types

  • Case Reports

MeSH terms

  • Abatacept
  • Fatal Outcome
  • Graft Rejection / prevention & control
  • Humans
  • Immunoconjugates / adverse effects*
  • Immunoconjugates / therapeutic use
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Pneumocystis carinii*
  • Pneumonia, Pneumocystis / diagnostic imaging
  • Pneumonia, Pneumocystis / etiology*
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / etiology*
  • Radiography
  • Superinfection / diagnostic imaging
  • Superinfection / etiology*


  • Immunoconjugates
  • Immunosuppressive Agents
  • Abatacept