Background: Regardless of recipient age at kidney transplantation (KTx), patients are at greatest risk for graft loss in adolescence. This is in part due to increased non-adherence to oral immunosuppressive drugs. Belatacept, a first-in-class immunosuppressive drug that inhibits co-stimulation of T-cells, not only lacks nephrotoxicity, but also requires intravenous application only every 4 weeks, which could potentially lead to better adherence in adolescents. However, belatacept is approved for use only in adults. We report here the findings of the first trial of belatacept in adolescents.

Methods: The study included all patients treated in our department who were switched to belatacept after KTx because of non-adherence to their immunosuppressive regimen. The switch was made under the compassionate use program approved by German law. For assessment of safety outcomes, we also report on two patients who received belatacept for other reasons.

Results: Six patients (median age 15.5 years) were switched to belatacept after KTx after a median of 7.5 months (range 23 days to 12 years). Observed treatment duration ranged between 3 and 28 months (cumulative 83 months). In the three patients switched early (<3 months after KTx) an increase in estimated glomerular filtration rate (eGFR) was observed. One patient switched 12 years after KTx has stable GFR. Two patients were switched after previous rapid decline of eGFR and with a markedly impaired GFR: slope in GFR decline was altered in one of these patients. A single acute rejection episode was observed in all six patients. Of the two patients who received belatacept for other conditions (recurrent FSGF after KTx, deteriorating diabetes mellitus under tacrolimus), clinically relevant neutropenia (halted after discontinuation of concomitant MMF) was the single adverse event observed after a cumulative 109 months.

Conclusion: Belatacept as primary immunosuppression is an option in EBV-seropositive non-adherent adolescents if administered sufficiently early before deterioration of graft function.

CITATION INFORMATION: Lerch C, Kanzeleyer N, Ahlenstiel-Grunow T, Froede K, Kreuzer M, Drube J, Pape L. Belatacept After Kidney Transplantation in Adolescents. Am J Transplant. 2017;17 (suppl 3).

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