Belatacept rescue conversion in kidney transplant recipients with vascular lesions (Banff cv score >2) : a retrospective cohort study
© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA..
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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 < .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 < .005).
CONCLUSION: 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. Caution should be exercised regarding the increased risk of opportunistic infection.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:38 |
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| Enthalten in: |
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association - 38(2023), 2 vom: 13. Feb., Seite 481-490 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bertrand, Dominique [VerfasserIn] |
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| Links: |
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| Themen: |
7D0YB67S97 |
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| Anmerkungen: |
Date Completed 14.02.2023 Date Revised 19.02.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/ndt/gfac178 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM340723068 |
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| 100 | 1 | |a Bertrand, Dominique |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Belatacept rescue conversion in kidney transplant recipients with vascular lesions (Banff cv score >2) |b a retrospective cohort study |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 19.02.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. | ||
| 520 | |a BACKGROUND: 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 | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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 < .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 < .005) | ||
| 520 | |a CONCLUSION: 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. Caution should be exercised regarding the increased risk of opportunistic infection | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Matignon, Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Morel, Antoine |e verfasserin |4 aut | |
| 700 | 1 | |a Ludivine, Lebourg |e verfasserin |4 aut | |
| 700 | 1 | |a Lemoine, Mathilde |e verfasserin |4 aut | |
| 700 | 1 | |a Hanoy, Mélanie |e verfasserin |4 aut | |
| 700 | 1 | |a Roy, Frank Le |e verfasserin |4 aut | |
| 700 | 1 | |a Nezam, Dorian |e verfasserin |4 aut | |
| 700 | 1 | |a Hamzaoui, Mouad |e verfasserin |4 aut | |
| 700 | 1 | |a de Nattes, Tristan |e verfasserin |4 aut | |
| 700 | 1 | |a Moktefi, Anissa |e verfasserin |4 aut | |
| 700 | 1 | |a François, Arnaud |e verfasserin |4 aut | |
| 700 | 1 | |a Laurent, Charlotte |e verfasserin |4 aut | |
| 700 | 1 | |a Etienne, Isabelle |e verfasserin |4 aut | |
| 700 | 1 | |a Guerrot, Dominique |e verfasserin |4 aut | |
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