Tacrolimus for the Treatment of Refractory Biopsy-Proven Acute Cellular Rejection in Patients on Belatacept-Based, CNI- and Steroid-Free Immunosuppression Regimens
1Univ of Cincinnati, Cincinnati
2The Christ Hospital, Cincinnati.
Meeting: 2015 American Transplant Congress
Abstract number: D160
Keywords: Biopsy, FK506, Multicenter studies, Rejection
Session Information
Session Name: Poster Session D: Kidney: Acute Rejection
Session Type: Poster Session
Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background: Tacrolimus (TAC) is effective as rescue treatment (tx) in renal transplant patients (pts) on cyclosporine-based immunosuppression (IS) who have recurrent or resistant acute rejection (AR) episodes. Clinical experience has suggested that pts on a belatacept (BELA)-based regimen may experience AR that is refractory to standard tx with corticosteroids (CS) or rabbit antithymocyte globulin (ATG). In these pts, TAC may be required to resolve the AR.
Methods: This study describes a subset of pts enrolled in a prospective, randomized, multicenter study who were on BELA and experienced refractory biopsy-proven acute cellular rejection (BPACR). Per protocol, recommended first-line tx for BPACR Banff IA or IB is pulse doses of CS followed by a CS taper; for BPACR ≥ Banff IIA, ATG for 7-14 days of CD3 suppression is recommended. Rescue tx with TAC may be used for refractory AR with a planned duration of 28 days (initial goal trough: 12-15 ng/mL). Data analysis was performed using descriptive statistics.
Results: 102/155 pts enrolled as of November 6, 2014, were randomized to a BELA-based regimen. 18 pts have had BPACR, with 6 (33%) experiencing refractory AR.
| Pt 1 | Pt 2 | Pt 3 | Pt 4 | Pt 5 | Pt 6 | ||
| Age, yrs | 56 | 60 | 54 | 55 | 35 | 72 | |
| Gender | M | M | F | M | M | M | |
| Race | W | W | AA | W | W | W | |
| Donor type | LD | LD | LD | LD | DD | DD | |
| cPRA, % | 0 | 0 | 64 | 0 | 8 | 0 | |
| IS at time of AR | anti-CD52; BELA; MMF; 5-d CS taper | anti-CD52; BELA; MMF; 5-d CS taper | ATG; BELA; MMF; 5-d CS taper | anti-CD52; BELA; MMF; daily CS | ATG; BELA; MMF; 5-d CS taper | anti-CD52; BELA; MMF; 5-d CS taper | |
| Overview – AR Episode | |||||||
| Baseline SCr, mg/dL | 1.6 | 1.6 | 1.4 | 1.3 | N/A | 1.4 | |
| Time to AR, days | 486 | 72 | 55 | 101 | 15 | 292 | |
| SCr at time of biopsy, mg/dL | 1.7 | 3.3 | 2.1 | 1.7 | 1.7 | 1.7 | |
| BANFF Grade | IB | IIB | IIA | IIA | IB | IIA | |
| Summary of AR tx | 1) ATG x10d CD3 supp; 2) Banff IA: CS; 3) ongoing IA: +TAC; 4) Banff IB: ↑MMF, ↑TAC trough | 1) ATG x14d CD3 supp, CS; 2) Banff IB: cont CS, +TAC | 1) ATG x14d CD3 supp, ↑MMF; 2) ongoing IIA: CS, +TAC | 1) ATG x14d CD3 supp; 2) ongoing IIA: CS, ↑MMF, +TAC | 1) CS; 2) +TAC for ongoing AR; 3) developed BKVN, now on TAC monotherapy | CS and TAC first-line | |
| Time to AR resolution, days | 105 | 37 | 23 | 26 | N/A | 11 | |
Patient and graft survival is 100%.
Conclusion: TAC seems effective as rescue tx for refractory BPACR in pts on BELA. More data are needed to evaluate the optimal goal TAC trough and tx duration in these pts.
To cite this abstract in AMA style:
Trobaugh K, Shields A, Tremblay S, Alloway R, Cardi M, Witte D, Paterno F, Cuffy M, Woodle E. Tacrolimus for the Treatment of Refractory Biopsy-Proven Acute Cellular Rejection in Patients on Belatacept-Based, CNI- and Steroid-Free Immunosuppression Regimens [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/tacrolimus-for-the-treatment-of-refractory-biopsy-proven-acute-cellular-rejection-in-patients-on-belatacept-based-cni-and-steroid-free-immunosuppression-regimens/. Accessed November 24, 2024.« Back to 2015 American Transplant Congress