12-Months Evolution of Anti-HLA Antibodies Donor Specific Antibodies after Rescue Switch from CNi-Based Immunosuppressive Regimen to Belatacept in Kidney Allograft Recipients
1Nephrology Transplantation, APHP Henri Mondor, Creteil, France
2Histocompatibility, APHP Saint Louis, Paris, France.
Meeting: 2018 American Transplant Congress
Abstract number: C73
Keywords: Immunosuppression, Rejection, Safety
Session Information
Session Name: Poster Session C: Kidney Immunosuppression: Novel Regimens and Drug Minimization
Session Type: Poster Session
Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Introduction
After kidney transplantation, long-term immunosuppression with calcineurin inhibitors (CNIs) or mTOR inhibitors (mTORi) leads to adverse effects, such as nephrotoxicity and proteinuria. Currently, available data support use of belatacept as rescue therapy in patients with suboptimal allograft function and/or proteinuria. Evolution of anti-HLA donor specific antibodies (DSA) after switch is not known.
Patients and methods
We conducted a retrospective study including all kidney allograft recipients (>18 years, EBV +), followed from 01/2012 and 12/2015, after conversion from CNI-based immunosuppressive regimen to belatacept at any time after transplant with 12 months follow-up after switch. We compared DSA before switch and 12-months after. DSAs were assessed with Luminex single-antigen bead assays.
Results
A total of 47 patients were included from 01/2012 and 12/2015. Switch median delay after transplant was 14 (3.25-52.75) months with N=12 (25%) early switches (<3 months).
DSA were detectable in 16 (34%) patients before the switch and 18 (38%) patients after 12-months. All DSAs characteristics were similar between both time points.
| Anti-HLA donor specific antibodies | At the time of switch | 12-months follow-up | P-value |
| Patients' number, N (%) | 47 (100) | 47 (100) | |
| Positive, N (%) | 16 (34) | 18 (38) | 0.83 |
| Class I, N (%) | 9 (56) | 6 (33) | 0.72 |
| Class I, Number, median (IQR) | 1 (1-1.5) | 1.5 (1-2) | 1.00 |
| Class I, MFI max, median (IQR) | 1130 (696-2188) | 1279 (945-2569) | 0.84 |
| Class I, MFI sum, median (IQR) | 1637 (664-2388) | 1983 (1460-2569) | 1.00 |
| Class II, N (%) | 11 (69) | 15 (83) | 0.43 |
| Class II, Number, median (IQR) | 1 (1-2) | 1 (1-2) | 1.00 |
| Class II, MFI max, median (IQR) | 1709 (1157-2911) | 1470 (704-3963) | 0.57 |
| Class II, MFI sum, median (IQR) | 2284 (1178-3495) | 1474 (1046-5941) | 0.57 |
Conclusion
Belatacept as rescue therapy is safe regarding immunologic risk with a comparable immunization at the time of the switch compared to 12-months follow-up whatever the characteristics of DSA is considered.
CITATION INFORMATION: Matignon M., Dudreuilh C., Rémy P., Taupin J-.L., Grimbert P. 12-Months Evolution of Anti-HLA Antibodies Donor Specific Antibodies after Rescue Switch from CNi-Based Immunosuppressive Regimen to Belatacept in Kidney Allograft Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Matignon M, Dudreuilh C, Rémy P, Taupin J-L, Grimbert P. 12-Months Evolution of Anti-HLA Antibodies Donor Specific Antibodies after Rescue Switch from CNi-Based Immunosuppressive Regimen to Belatacept in Kidney Allograft Recipients [abstract]. https://atcmeetingabstracts.com/abstract/12-months-evolution-of-anti-hla-antibodies-donor-specific-antibodies-after-rescue-switch-from-cni-based-immunosuppressive-regimen-to-belatacept-in-kidney-allograft-recipients/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress