Belatacept rescue conversion in kidney transplant recipients with vascular lesions (Banff cv score >2):  a retrospective cohort study. Issue 2 (11th May 2022)

• Record Type: Journal Article
• Authors: Bertrand, Dominique; Matignon, Marie; Morel, Antoine; Ludivine, Lebourg; Lemoine, Mathilde; Hanoy, Mélanie; Roy, Frank Le; Nezam, Dorian; Hamzaoui, Mouad; de Nattes, Tristan; Moktefi, Anissa; François, Arnaud; Laurent, Charlotte; Etienne, Isabelle; Guerrot, Dominique
• Is Part Of: Nephrology dialysis transplantation. Volume 38:Issue 2(2023)
• Page Start: 481
• Page End: 490
• Publication Date: 2022-05-11
• Subjects: belatacept -- conversion -- graft survival -- kidney transplantation -- opportunistic infection; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfac178
• Languages: English
• ISSNs: 0931-0509

Abstract

ABSTRACT: Background: Immunosuppression in kidney transplant recipients with decreased graft function and histological vascular changes can be particularly challenging. The impact of a late rescue conversion to belatacept on kidney graft survival in this context has never been studied. Methods: We report a bicentric retrospective cohort study comparing a calcineurin inhibitor (CNI) to belatacept switch versus CNI continuation in 139 kidney transplant recipients with histological kidney vascular damage (cv ≥2, g + cpt ≤1, i + t ≤1) and low estimated glomerular filtration rate (≤40 mL/min/1.73 m²). Primary outcome was death-censored graft survival. Results: During the study follow-up, 10 graft losses (14.5%) occurred in the belatacept group ( n = 69) versus 26 (37.1%) in the matched CNI group ( n = 70) ( P = .005). Death-censored graft survival was significantly higher in the belatacept group ( P = .001). At 3 years, graft survival was 84.0% in the belatacept group compared with 65.1% in the control group. Continuing CNI was an independent risk factor for graft loss [hazard ratio (HR) 3.46; P < .005]. The incidence of cellular rejection after the conversion was low (4.3% in both groups) and not significantly different between groups ( P = .84). Patients switched to belatacept developed significantly less donor-specific antibodies de novo . Belatacept was an independent risk factor for the occurrence of opportunistic infections (HR 4.84; P < .005). Conclusion: The replacement of CNI with belatacept in patients with decreased allograft function and vascular lesions is associated with an improvement in graft survival and represents a valuable option in a context of organ shortage. Caution should be exercised regarding the increased risk of opportunistic infection. Graphical Abstract: