INTRODUCTION: Cytomegalovirus (CMV) remains associated with poor outcomes after kidney transplantation (kTx). The impact of belatacept on CMV infection remains understudied. In this study, we assessed the impact of belatacept on patient and graft survivals. METHODS: CMV seronegative kTx recipients were included. Patient and graft survival were studied using Kaplan-Meier method, log-rank test. Cox models were used to compare outcomes by CMV risk and immunosuppressive regimen. Incidence and persistence of CMV viremia under belatacept vs tacrolimus were compared. RESULTS: Among 308 CMV seronegative recipients, 168 CMV high-risk and 203 belatacept-treated patients were included. High-risk CMV status was associated with lower patient survival and graft survival. Among the CMV high-risk group, patients treated with belatacept presented a higher incidence of CMV viremia, a higher rate of first-line treatment failure and a longer time to virus clearance. They had a nonsignificant trend toward a lower graft survival. CONCLUSION: Belatacept-based maintenance immunosuppression is associated with an increased risk of CMV primary-infection and a prolonged course of viral replication in CMV high-risk patients. Further studies are needed to confirm the nonsignificant trend towards a lower graft survival in CMV high-risk patients treated with belatacept and whether it is explained by the higher risk of CMV reactivation and infection.
INTRODUCTION: Cytomegalovirus (CMV) remains associated with poor outcomes after kidney transplantation (kTx). The impact of belatacept on CMV infection remains understudied. In this study, we assessed the impact of belatacept on patient and graft survivals. METHODS: CMV seronegative kTx recipients were included. Patient and graft survival were studied using Kaplan-Meier method, log-rank test. Cox models were used to compare outcomes by CMV risk and immunosuppressive regimen. Incidence and persistence of CMV viremia under belatacept vs tacrolimus were compared. RESULTS: Among 308 CMV seronegative recipients, 168 CMV high-risk and 203 belatacept-treated patients were included. High-risk CMV status was associated with lower patient survival and graft survival. Among the CMV high-risk group, patients treated with belatacept presented a higher incidence of CMV viremia, a higher rate of first-line treatment failure and a longer time to virus clearance. They had a nonsignificant trend toward a lower graft survival. CONCLUSION: Belatacept-based maintenance immunosuppression is associated with an increased risk of CMV primary-infection and a prolonged course of viral replication in CMV high-risk patients. Further studies are needed to confirm the nonsignificant trend towards a lower graft survival in CMV high-risk patients treated with belatacept and whether it is explained by the higher risk of CMV reactivation and infection.
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: Sahra Pajenda; Sebastian Kapps; Daniela Gerges; Gregor Hoermann; Ludwig Wagner; Nina Buchtele; Barbara Geist; Robert Strassl; Alice Schmidt; Wolfgang Winnicki Journal: BMC Nephrol Date: 2021-05-08 Impact factor: 2.388
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