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

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...

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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
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cited_by cdi_FETCH-LOGICAL-c289t-890b6b712232dffb4beae8952a2f36cd1541b632700e5ae7a0f31cbb6310d26c3
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container_title Nephrology, dialysis, transplantation
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creator 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
description 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 
doi_str_mv 10.1093/ndt/gfac178
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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 &lt; .005]. The incidence of cellular rejection after the conversion was low (4.3% in both groups) and not significantly different between groups (P = .84). Patients switched to belatacept developed significantly less donor-specific antibodies de novo. Belatacept was an independent risk factor for the occurrence of opportunistic infections (HR 4.84; P &lt; .005). The replacement of CNI with belatacept in patients with decreased allograft function and vascular lesions is associated with an improvement in graft survival and represents a valuable option in a context of organ shortage. 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The incidence of cellular rejection after the conversion was low (4.3% in both groups) and not significantly different between groups (P = .84). Patients switched to belatacept developed significantly less donor-specific antibodies de novo. Belatacept was an independent risk factor for the occurrence of opportunistic infections (HR 4.84; P &lt; .005). The replacement of CNI with belatacept in patients with decreased allograft function and vascular lesions is associated with an improvement in graft survival and represents a valuable option in a context of organ shortage. 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source Oxford Journals Online
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
title Belatacept rescue conversion in kidney transplant recipients with vascular lesions (Banff cv score >2):  a retrospective cohort study
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