*Purpose: Selective co-stimulatory blockade with belatacept has demonstrated long-term benefits in renal transplantation, with improved glomerular filtration rate and decreased risk of death and graft loss compared to calcineurin inhibitor (CNI) based regimens. While its use in renal transplantation is expanding, there is a paucity of data on the use of belatacept in non-renal solid organ transplant recipients. Nevertheless, belatacept may be of benefit in extra-renal organ transplantation where CNI induced renal dysfunction and toxicity are barriers to improved outcomes. Here, we present our institutional experience using belatacept in de novo renal transplant recipients who have previously undergone a non-renal solid organ transplant.

*Methods: We reviewed our institutional database and identified 7 patients who received a renal transplant and were initiated on belatacept after a previous non-renal solid organ transplant. Simultaneous kidney plus non-renal organ transplants were excluded. A retrospective chart review was then performed.

*Results: Prior solid organ transplants in this cohort consisted of 1 heart, 1 double-lung, 1 kidney-pancreas, and 4 livers. The median time from initial organ transplant to renal transplant was 84 months (range 7 – 285). These patients were initiated on our standard renal transplant belatacept-based protocol consisting of basiliximab induction, transient CNI therapy, and belatacept, mycophenolate mofetil and prednisone maintenance. We have observed 100% patient and allograft survival. Median time post-kidney transplant and on belatacept has been 7 months (range 2 – 87), and all allografts (renal and non-renal) continue to demonstrate good function. There have been no episodes of acute celluar rejection (ACR) in the renal allografts. A single episode of clinically insignificant cardiac grade 1A ACR occurred in the heart transplant recipient 3 years after renal transplant and did not require treatment. De-novo donor specific antibodies have not formed in any of the recipients and there have been no clinically apparent protective immunity concerns. One liver recipient discontinued belatacept infusions after 12 months due to vascular access difficulties.

*Conclusions: This case series provides evidence that renal transplant recipients with a previous history of non-renal solid organ transplants can be successfully treated with belatacept. Belatacept was safe and well tolerated in this subset of patients, suggesting a role for maintenance therapy in extra-renal transplantation. Future clinical studies utilizing belatacept in these organ classes should be considered.

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