Belatacept Based Immunosuppression and Incidence of Proteinuria in Kidney Transplant Recipients

R. Villicana, A. Peng, J. Kahwaji, J. Choi, A. Vo, S. Jordan.

Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.

Meeting: 2015 American Transplant Congress

Abstract number: 310

Keywords: Co-stimulation, Kidney transplantation, Proteinuria

Session Information

Session Name: Concurrent Session: Kidney: Novel Agents

Session Type: Concurrent Session

Date: Monday, May 4, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 5:12pm-5:24pm

Location: Terrace I-III

Introduction: Abatacept which is a co-stimulation inhibitor has been suggested to have B7-1 mediated antiproteinuric effects. Belatacept which is another co-stimulation agent has been approved for kidney transplantation. We report the incidence and etiologies of proteinuria in kidney transplant patients maintained on Belatacept.

Methods: All adult kidney transplant recipients maintained on a Belatacept based regimen and had a least 1 month of follow-up were included. Belatacept denovo and conversion patients were included. Proteinuria was defined as a spot urine protein/creatinine ratio of 0.5 or higher.

Results: 39 patients were included in the analysis (15 denovo and 24 conversion patients). Follow-up ranged from 2-31 months with an avg of 14.6 months of f/u. Causes of esrd included DM 17/39 pts and12/39 pts had GN (4 with fsgs). 15 pts received living donor transplants, 16 were ecd recipients and 8 pts received scd transplants. 5/39 pts were on ace or arb therapy. 27 pts received t-cell depleting induction agents and 12 received Il-2 antagonists. DSA analysis was performed in 29/39 pts (74%). 27 pts had no dsa and 2 pts had pre-existing dsa at time of conversion that didn't change post conversion. Average creatinine was 1.54 mg/dl in both denovo and conversion pts (range 0.7-2.4).

Proteinuria was present in 3/15 denovo Belatacept patients. Etiology included cell mediated rejection in one pt, non-diagnostic bx in another pt and third pt refused bx but proteinuria felt due to everolimus. Proteinuria ranged from 0.5 to 2.3 on urine pro/cr ratio. 7/24 Belatacept conversion pts had proteinuria. Etiologies included cni toxicity and thrombotic microangiopathy. No pt had evidence of recurrent GN. Proteinuria ranged from 0.5 to 3.1 on spot urine pro/cr ratio in conversion pts.

Conclusion:

Proteinuria in pts on Belatacept based therapy is common. Conversion pts seem to have higher incidence 29% vs 20%. Proteinuria is generally sub-nephrotic range and not associated with development of DSA. The association of co-stimulation blockade with Belatacept based therapy and post-transplant proteinuria needs further study. Of note, only 4 pts with hx of esrd due to fsgs were in study and none had recurrence.

To cite this abstract in AMA style:

Villicana R, Peng A, Kahwaji J, Choi J, Vo A, Jordan S. Belatacept Based Immunosuppression and Incidence of Proteinuria in Kidney Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/belatacept-based-immunosuppression-and-incidence-of-proteinuria-in-kidney-transplant-recipients/. Accessed December 3, 2024.

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