Dominique Bertrand1, Nathalie Chavarot2, Philippe Gatault3, Cyril Garrouste4, Nicolas Bouvier5, Anne Grall-Jezequel6, Maïté Jaureguy7, Sophie Caillard8, Mathilde Lemoine9, Charlotte Colosio10, Léonard Golbin11, Jean-Philippe Rerolle12, Antoine Thierry13, Johnny Sayegh14, Isabelle Etienne1, Ludivine Lebourg1, Rebecca Sberro2, Dominique Guerrot1. 1. Department of Nephrology, Rouen University Hospital, Rouen, France. 2. Department of Adult Kidney Transplantation, Necker-Enfants Malades University Hospital, Paris, France. 3. Department of Nephrology, Tours University Hospital, Tours, France. 4. Department of Nephrology, Clermont Ferrand University Hospital, Clermont Ferrand, France. 5. Department of Nephrology, Caen University Hospital, Caen, France. 6. Department of Nephrology, Brest University Hospital, Brest, France. 7. Department of Nephrology, Amiens University Hospital, Amiens, France. 8. Department of Nephrology, Strasbourg University Hospital, Strasbourg, France. 9. Department of Nephrology, European Georges Pompidou University Hospital, Paris, France. 10. Department of Nephrology, Reims University Hospital, Reims, France. 11. Department of Nephrology, Rennes University Hospital, Rennes, France. 12. Department of Nephrology, Limoges University Hospital, Limoges, France. 13. Department of Nephrology, Poitiers University Hospital, Poitiers, France. 14. Department of Nephrology, Angers University Hospital, Angers, France.
Abstract
BACKGROUND: Belatacept (bela) rescue therapy seems to be a valuable option for calcineurin inhibitor chronic toxicity in kidney transplantation. Nevertheless, the risk of infection associated with bela is not well reported. METHODS: We report the rate of opportunistic infections (OPI) after a switch to bela in a multicentric cohort of 280 kidney transplant patients. RESULTS: Forty-two OPI occurred in 34 patients (12.1%), on average 10.8 ± 11.3 months after the switch. With a cumulative exposure of 5128 months of bela treatment, we found an incidence of 0.008 OPI/month of exposure, and 9.8 OPI/100 person-years. The most common OPI was cytomegalovirus (CMV) disease in 18/42 OPI (42.9%) and pneumocystis pneumonia in 12/42 OPI (28.6%). Two patients presented a progressive multifocal leucoencephalopathy and two patients developed a cerebral Epstein-Barr virus-induced post-transplant lymphoproliferative disease. OPI led to death in 9/34 patients (26.5%) and graft failure in 4/34 patients (11.8%). In multivariate analysis, estimated glomerular filtration rate <25/mL/min/1.73 m2 on the day of the switch and the use of immunosuppressive agents before transplantation were associated with the occurrence of OPI. We found a higher rate of infection-related hospitalization (24.1 versus 12.3/100 person-years, P = 0.0007) and also a higher rate of OPI (13.2 versus 6.7/100 person-years, P = 0.005) in the early conversion group (within 6 months). CONCLUSIONS: The risk of OPI is significant post-conversion to bela and may require additional monitoring and prophylactic therapy, particularly regarding pneumocystis pneumonia and CMV disease. These data need to be confirmed in a larger case-control study.
BACKGROUND: Belatacept (bela) rescue therapy seems to be a valuable option for calcineurin inhibitor chronic toxicity in kidney transplantation. Nevertheless, the risk of infection associated with bela is not well reported. METHODS: We report the rate of opportunistic infections (OPI) after a switch to bela in a multicentric cohort of 280 kidney transplant patients. RESULTS: Forty-two OPI occurred in 34 patients (12.1%), on average 10.8 ± 11.3 months after the switch. With a cumulative exposure of 5128 months of bela treatment, we found an incidence of 0.008 OPI/month of exposure, and 9.8 OPI/100 person-years. The most common OPI was cytomegalovirus (CMV) disease in 18/42 OPI (42.9%) and pneumocystis pneumonia in 12/42 OPI (28.6%). Two patients presented a progressive multifocal leucoencephalopathy and two patients developed a cerebral Epstein-Barr virus-induced post-transplant lymphoproliferative disease. OPI led to death in 9/34 patients (26.5%) and graft failure in 4/34 patients (11.8%). In multivariate analysis, estimated glomerular filtration rate <25/mL/min/1.73 m2 on the day of the switch and the use of immunosuppressive agents before transplantation were associated with the occurrence of OPI. We found a higher rate of infection-related hospitalization (24.1 versus 12.3/100 person-years, P = 0.0007) and also a higher rate of OPI (13.2 versus 6.7/100 person-years, P = 0.005) in the early conversion group (within 6 months). CONCLUSIONS: The risk of OPI is significant post-conversion to bela and may require additional monitoring and prophylactic therapy, particularly regarding pneumocystis pneumonia and CMV disease. These data need to be confirmed in a larger case-control study.
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