Background: Data with belatacept has demonstrated that patients on de novo belatacept have better renal function and improved patient and graft survival seven years post-transplant. However, in an era of kidney transplantation where graft survival has plateaued, taking into account quality of life on immunosuppression is important. Given the number of drug toxicities immunosuppressants have, these can have a significant impance on quality of lifeWe report our experience with belatacept as a conversion due to drug induced toxicities from calcineurin inhibitors (CNI), tacrolimus and cyclosporine and the mTor inhibitor sirolimus.

Methods: A retrospective chart review was conducted of adult kidney transplant recipients at our center who were converted at least one month after transplant to belatacept from either a CNI or mTOR inhibitor with one year of follow-up. Patients were excluded for de novo belatacept and incomplete medical record. Data was collected at baseline, one month, then quarterly for one year after conversion. The primary outcome was indication for changing immunosuppression. Secondary outcomes include change in toxicity, change in renal function, rates of failed conversion, and biopsy proven acute rejection (BPAR).

Results: We evaluated 75 patients converted to belatacept with one year of follow-up. Of these, five patients were excluded, leaving 70 patients reported here. Fifty-one patients were converted from a CNI and 19 patients converted from sirolimus. Indications for conversion from a CNI included memory impairment (39%), tremors (22%), seizure (6%), nephrotoxicity (10%), alopecia (8%), and other (15%). Patients converted from sirolimus for edema (47%), cholesterol (21%), wound healing (11%), pneumonitis (11%), and other (10%). Out of all patients, 70% had subjective or objective improvement in their drug toxicity. Average serum creatinine at time of conversion was 1.56mg/dL and 1.35mg/dL one year post-conversion. Six patients (9%) had a failed conversion requiring returning to their original immunosuppressant or alternative agent. There were three cases of BPAR within one year post-conversion.

Conclusion: Patients can be successfully converted to belatacept improving their drug toxicities. Further studies are needed to evaluate the primary indication for conversion to belatacept, neurotoxicities.

CITATION INFORMATION: Cohen E, Knight B, Asch W. More Than Renal Function: Use of Belatacept to Improve Drug Toxicities. Am J Transplant. 2017;17 (suppl 3).

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