M Dürr1, N Lachmann2, B Zukunft1, D Schmidt1, K Budde1, S Brakemeier3. 1. Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany. 2. HLA Laboratory, Zentrum für Tumormedizin, Charité Universitätsmedizin Berlin, Berlin, Germany. 3. Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany. Electronic address: susanne.brakemeier@charite.de.
Abstract
BACKGROUND: Conversion to belatacept at a later point after kidney transplantation (KT) as a rescue therapy has been shown to be beneficiary in an increasing number of patients, but prognostic factors for a favorable outcome have never been investigated. METHODS: The present study analyzed all KT patients after late conversion to belatacept in a single center regarding graft survival and changes in estimated glomerular filtration rate (eGFR), proteinuria, and mean fluorescence intensity (MFI) of donor-specific antibodies (DSA). RESULTS: A total of 69 KT patients were converted to belatacept. eGFR increased from 28.9 ± 18.2 mL/min/1.73 m2 at time of conversion to 34.8 ± 20.1 mL/min/1.73 m2 after 18 months (P = .025). After conversion, 26/69 patients (37.7%) showed a sustained increase in eGFR of >5 mL/min/1.73 m2 after 12 months and were defined as responders. All other patients (43/69, 62.3%) were defined as nonresponders. In multivariate analysis, nonresponders presented with significantly higher proteinuria (552 ± 690 vs 165 ± 158 mg/L; P = .004) at the time of conversion. Changes of eGFR from before conversion and the time of conversion were similar in both subgroups (-5.7 ± 9.2 and 29.2 ± 17.3 mL/min/1.73 m2 in responders and -4.6 ± 10.7 and 28.7 ± 19.0 mL/min/1.73 m2 in nonresponders). HLA antibody panel reactivity did not change after conversion. DSA-MFI was higher in nonresponders (7,155 ± 6,785) than in responders (2,336 ± 2,173; P = .001). One patient (1/69, 1.4%) developed de novo DSA after conversion, and no antibody-mediated rejection was diagnosed within 1,540 treatment months. CONCLUSIONS: Late conversion to belatacept is beneficiary for a subgroup of patients, with lower proteinuria at the time of conversion being an indicator for a favorable outcome.
BACKGROUND: Conversion to belatacept at a later point after kidney transplantation (KT) as a rescue therapy has been shown to be beneficiary in an increasing number of patients, but prognostic factors for a favorable outcome have never been investigated. METHODS: The present study analyzed all KT patients after late conversion to belatacept in a single center regarding graft survival and changes in estimated glomerular filtration rate (eGFR), proteinuria, and mean fluorescence intensity (MFI) of donor-specific antibodies (DSA). RESULTS: A total of 69 KT patients were converted to belatacept. eGFR increased from 28.9 ± 18.2 mL/min/1.73 m2 at time of conversion to 34.8 ± 20.1 mL/min/1.73 m2 after 18 months (P = .025). After conversion, 26/69 patients (37.7%) showed a sustained increase in eGFR of >5 mL/min/1.73 m2 after 12 months and were defined as responders. All other patients (43/69, 62.3%) were defined as nonresponders. In multivariate analysis, nonresponders presented with significantly higher proteinuria (552 ± 690 vs 165 ± 158 mg/L; P = .004) at the time of conversion. Changes of eGFR from before conversion and the time of conversion were similar in both subgroups (-5.7 ± 9.2 and 29.2 ± 17.3 mL/min/1.73 m2 in responders and -4.6 ± 10.7 and 28.7 ± 19.0 mL/min/1.73 m2 in nonresponders). HLA antibody panel reactivity did not change after conversion. DSA-MFI was higher in nonresponders (7,155 ± 6,785) than in responders (2,336 ± 2,173; P = .001). One patient (1/69, 1.4%) developed de novo DSA after conversion, and no antibody-mediated rejection was diagnosed within 1,540 treatment months. CONCLUSIONS: Late conversion to belatacept is beneficiary for a subgroup of patients, with lower proteinuria at the time of conversion being an indicator for a favorable outcome.
Authors: Tom C Zwart; Sumit R M Gokoel; Paul J M van der Boog; Johan W de Fijter; Dina M Kweekel; Jesse J Swen; Henk-Jan Guchelaar; Dirk Jan A R Moes Journal: Br J Clin Pharmacol Date: 2018-10-15 Impact factor: 4.335
Authors: Antoine Morel; Léa Hoisnard; Caroline Dudreuilh; Anissa Moktefi; David Kheav; Ana Pimentel; Hamza Sakhi; David Mokrani; Philippe Attias; Karim El Sakhawi; Cécile Maud Champy; Philippe Remy; Emilie Sbidian; Philippe Grimbert; Marie Matignon Journal: Transpl Int Date: 2022-04-13 Impact factor: 3.842