Amandine Darres1, Camillo Ulloa2, Susanne Brakemeier3, Cyril Garrouste4, Oriol Bestard5, Arnaud Del Bello1, Rebecca Sberro Soussan2, Michael Dürr3, Klemens Budde3, Christophe Legendre2, Nassim Kamar1,6,7. 1. Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France. 2. Service de Néphrologie-Transplantation, Hôpital Necker, AP-HP, Paris et Université Paris Descartes, Paris. 3. Division of Nephrology, Department of Nephrology and Medical Intensive Care, Charité, Berlin, Germany. 4. CHU Clermont-Ferrand, Service de Néphrologie, Clermont-Ferrand, France. 5. Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain. 6. INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France. 7. Université Paul Sabatier, Toulouse, France.
Abstract
BACKGROUND: The use of belatacept is not yet approved for maintenance in kidney transplant patients. This retrospective multicenter European study aimed to assess the efficacy and safety of conversion to belatacept in a large cohort of patients in a real-life setting and to identify the predictive factors for improved kidney function after the switch. METHODS: Two hundred nineteen maintenance kidney transplant patients from 5 European kidney transplant centers were converted to belatacept at 21.2 months (0.1-337.1 months) posttransplantation, mainly because of impaired kidney function. Thirty-two patients were converted to belatacept within the first 3 months posttransplantation. The mean duration of follow-up was 21.9 ± 20.2 months. RESULTS: The actuarial rate of patients still on belatacept-based therapy was 77.6%. Mean estimated glomerular filtration rate increased from 32 ± 16.4 at baseline to 38 ± 20 mL/min per 1.73 m (P < 0.0001) at last follow-up. Conversion to belatacept before 3 months posttransplantation was the main predictive factor for a significant increase in estimated glomerular filtration rate (of 5 and 10 mL/min per 1.73 m at 3 and 12 months after the switch, respectively). Eighteen patients (8.2%) presented with an acute rejection episode after conversion; 3 developed a donor-specific antibody. Overall efficacy and safety were good, including for the 35 patients that had a donor-specific antibody at conversion. CONCLUSIONS: The conversion to belatacept was effective, especially when performed early after transplantation.
BACKGROUND: The use of belatacept is not yet approved for maintenance in kidney transplantpatients. This retrospective multicenter European study aimed to assess the efficacy and safety of conversion to belatacept in a large cohort of patients in a real-life setting and to identify the predictive factors for improved kidney function after the switch. METHODS: Two hundred nineteen maintenance kidney transplantpatients from 5 European kidney transplant centers were converted to belatacept at 21.2 months (0.1-337.1 months) posttransplantation, mainly because of impaired kidney function. Thirty-two patients were converted to belatacept within the first 3 months posttransplantation. The mean duration of follow-up was 21.9 ± 20.2 months. RESULTS: The actuarial rate of patients still on belatacept-based therapy was 77.6%. Mean estimated glomerular filtration rate increased from 32 ± 16.4 at baseline to 38 ± 20 mL/min per 1.73 m (P < 0.0001) at last follow-up. Conversion to belatacept before 3 months posttransplantation was the main predictive factor for a significant increase in estimated glomerular filtration rate (of 5 and 10 mL/min per 1.73 m at 3 and 12 months after the switch, respectively). Eighteen patients (8.2%) presented with an acute rejection episode after conversion; 3 developed a donor-specific antibody. Overall efficacy and safety were good, including for the 35 patients that had a donor-specific antibody at conversion. CONCLUSIONS: The conversion to belatacept was effective, especially when performed early after transplantation.
Authors: Klemens Budde; Rohini Prashar; Hermann Haller; María Rial; Nassim Kamar; Avinash Agarwal; Johan de Fijter; Lionel Rostaing; Stefan Berger; Arjang Djamali; Nicolae Leca; Lisa Allamassey; Sheng Gao; Martin Polinsky; Flavio Vincenti Journal: J Am Soc Nephrol Date: 2021-10-27 Impact factor: 10.121
Authors: Idelberto R Badell; Ronald F Parsons; Geeta Karadkhele; Octav Cristea; Sue Mead; Shine Thomas; Jennifer M Robertson; Grace S Kim; John J Hanfelt; Stephen O Pastan; Christian P Larsen Journal: Am J Transplant Date: 2021-03-17 Impact factor: 9.369
Authors: Peter W Nickerson; Robert Balshaw; Chris Wiebe; Julie Ho; Ian W Gibson; Nancy D Bridges; David N Rush; Peter S Heeger Journal: Am J Transplant Date: 2020-10-06 Impact factor: 8.086