Belatacept rescue conversion in kidney transplant recipients with vascular lesions (Banff cv score >2):  a retrospective cohort study

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2023-02, Vol.38 (2), p.481-490
• Main 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
• Format: Article
• Language: English
• Subjects: Abatacept - therapeutic use; Calcineurin Inhibitors - therapeutic use; Graft Rejection - etiology; Graft Rejection - prevention & control; Graft Survival; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - adverse effects; Retrospective Studies; Transplant Recipients
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfac178

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. 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. 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