Tacrolimus to Belatacept Conversion Following Hand Transplantation: A Case Report.

Vascularized composite allotransplantation (VCA) has emerged as a viable limb replacement strategy for selected patients with upper limb amputation. However, allograft rejection has been seen in essentially all reported VCA recipients indicating a requirement for substantial immunosuppressive therapy. Calcineurin inhibitors have served as the centerpiece agent in all reported cases, and CNI-associated complications associated with the broad therapeutic effects and side effects of calcineurin inhibitors have been similarly common. Recently, belatacept has been approved as a calcineurin inhibitor replacement in kidney transplantation, but to date, its use in VCA has not been reported. Herein, we report on the case of a hand transplant recipient who developed recurrent acute rejection with alloantibody formation and concomitant calcineurin inhibitor nephrotoxicity, all of which resolved upon conversion from a maintenance regimen of tacrolimus, mycophenolate mofetil and steroids to belatacept and sirolimus. This case indicates that belatacept may be a reasonable maintenance immunosuppressive alternative for use in VCA, providing sufficient prophylaxis from rejection with a reduced side effect profile, the latter being particularly relevant for nonlife threatening conditions typically treated by VCA.

Nutrition and HIV infection. A continuum of care.

Nutrition is a fundamental intervention in the early and ongoing treatment of human immunodeficiency virus (HIV) disease. Nutrition therapy, in coordination with other medical interventions, can extend and improve the quality and quantity of life in individuals infected with HIV and living with acquired immune deficiency syndrome (AIDS). The author reviews the current literature and practice for nutrition use in the treatment of patients with HIV and AIDS.

Fractionation of plasma triglyceride-rich lipoproteins of the dairy cow: evidence of chylomicron-size particles.

Electron micrographs of bovine triglyceride-rich lipoproteins demonstrated spherical particles with diameters up to 3000 A. Chylomicron-size particles (larger than 750 A) were isolated specifically by rate zonal centrifugation. Subfractionation by rate zonal centrifugation, isopycnic centrifugation, and gel filtration chromatography all indicated a wide range of bovine triglyceride-rich lipoproteins from chylomicrons to very low density lipoproteins. Chemical analysis of subfractions from gel filtration showed changes in the ratio of triglyceride/protein characteristic of chylomicrons versus very low density lipoproteins. Electrophoretic analysis on agarose gels of bovine chylomicrons obtained by centrifugation and gel filtration showed migrating bands similar to very low density lipoproteins, unlike human chylomicrons. Evidence of bovine chylomicrons provides support for the concept of a significant contribution to milk fat from intestinally absorbed lipid in the dairy cow.