*Purpose: Calcineurin inhibitors (CNIs) and steroids are strongly associated with new-onset diabetes after transplantation (NODAT), worsening of pre-existing diabetes, and cardiovascular events. We assessed the benefit of conversion from CNI-based to belatacept-based immunosuppression in diabetic kidney-transplant (KT) recipients on glucose control and cardiovascular-risk factors.

*Methods: In this retrospective, non-controlled single-study conducted between May 2016 and October 26, 2018, we recruited KT recipients converted from CNIs to belatacept at least 6 months after KT. The primary endpoint was the evolution of HbA1c between baseline and after 6 months of treatment. Secondary endpoints included modifications to antidiabetic drugs, other cardiovascular risk factors, and renal function.

*Results: One hundred and three KT recipients were included. Of these, 26 (25%) had type-2 diabetes. The patients were either receiving oral antidiabetic drugs (n=21; 75%) or insulin-therapy (n=14; 54%). Overall HbA1c decreased significantly from 6.2±1 to 5.8 ± 1%, p < 0.0001. In diabetic patients, HbA1c decreased from 7.2±1 to 6.5 ± 1%, p=0.001. HbA1c significantly decreased in the subgroup of patients with new-onset diabetes at post transplantation and whether diabetes was controlled at inclusion or not (i.e., HA1c ≤7% or >7%). Moreover, no diabetic patient increased the number of oral anti-diabetic drugs and the dose of basal insulin was not statistically different from baseline to 6 months (16 UI at baseline and 16 UI at 6 months, p = 1). One patient had to start a treatment by insulin pump. During follow-up, the renal function, BMI and hemoglobin level of all 103 patients remained stable, two patients presented acute cellular rejection and no patient suffered from graft loss.

*Conclusions: A late switch from CNI to belatacept was a valuable therapeutic option for diabetic kidney recipients and substantially improved glycemic parameters.

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