LAUSR

report A recently published report titled “Increased incidence and unusual presentations of CMV disease in kidney transplant recipients after conversion to belatacept” by Chavarot et al. observed that patients converted to belatacept have a sevenfold higher incidence of cytomegalovirus (CMV) disease and atypical, aggressive disease phenotype. 1 These results coincided with earlier published studies that similarly observed that belatacept-based maintenance immunosuppression regimens in kidney transplant recipients are associated with increased rates of opportunistic infections, particularly primary CMV infections with prolonged viral replication in high-risk (seroneg-ative recipient receiving a graft from seropositive donor, D + /R-) patients. 2,3 We concur with these findings and propose the etiology may be attributed to a prolonged inhibitory effect of belatacept on CMV-specific cell-mediated immunity (CMI), which persists beyond discontinuation, based on our experience with the following case (Figure