Early Conversion to Belatacept in Kidney Transplant Recipients With Low Glomerular Filtration Rate. Issue 3 (March 2018)

• Record Type: Journal Article
• Authors: Abdelwahab Elhamahmi, Dina; Heilman, Raymond L.; Smith, Byron; Huskey, Janna; Khamash, Hasan; Kaplan, Bruce
• Is Part Of: Transplantation. Volume 102:Issue 3(2018)
• Publication Date: 2018-03
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000001985
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Our aim was to determine the impact of converting from tacrolimus to belatacept in patients with stable low estimated glomerular filtration rate (eGFR) early after kidney transplant. Methods: This is a single-center retrospective case control study. During this study period, we had a clinical protocol to convert patients to belatacept if they had a stable but low GFR and they were at least 1-month posttransplant. Eligible patients had stable but low eGFR usually < 40 mL/min per 1.73 m 2 . We used direct matching to select 1 control case for each patient converted to belatacept. The primary outcome was the change in eGFR from the point of belatacept conversion to 4 months postconversion (delta eGFR). Results: There were 30 patients in the conversion group and 30 in a direct matched control group. The median preconversion eGFR for the entire cohort was 23.0 mL/min per 1.73 m 2 with an interquartile range of 15.7 to 31.4. The delta eGFR was 11.0 (12.9) mL/min per 1.73 m 2 in belatacept group and 4.8 (10.5) mL/min per 1.73 m 2 in the control group ( P = 0.045). Acute rejection postconversion occurred in 5 (16.7%) in the conversion group and none of the control group ( P = 0.052). Although the delta improvement in eGFR was about 6 mL/min better in the Belatacept group, there was no difference in the slope of inverse creatinine during the 12-month period after conversion between the groups. Conclusions: We conclude that early belatacept conversion in kidney transplant recipients with stable low eGFR may only result in a modest increase in GFR. Abstract : This single-center retrospective cohort study including a matched control group shows modest increase in glomerular filtration rate, but a higher incidence of acute rejection in kidney transplant recipients with reduce renal function converted from calcineurin inhibitor to belatacept, underscoring the difficulties associated with conversion to CNI-free immunosuppressive strategies.