Background: Calcineurin inhibition (CNI) is the single most effective strategy to prevent allograft rejection however tolerability is limited by toxicity. To date, alternate strategies have been limited by serious adverse reactions including reduced patient & graft survival. Belatacept, a novel costimulatory blockade agent approved for de novo rejection prophylaxis, offers a potential alternate conversion strategy for patients with serious CNI toxicity.

Methods: A retrospective cohort study of adult KT recipients who transitioned from CNI to belatacept between March 2012 and August 2015 was performed. Data on allograft function was collected at baseline, 3 months and 6 months. Primary outcome was the number of patients that remained on belatacept therapy. Secondary outcomes include change in allograft function using serum creatinine (Scr), calculated creatinine clearance (CrCl), graft failures, death, and tolerance.

Results: Twenty-three kidney transplant recipientstransitioned from CNI to belatacept were identified. All patients were Caucasian, mean age was 53 years and 55% were female. Indication for belatacept conversion included the following: advanced chronic allograft nephropathy (CAN) 35 %, acute nephrotoxicity 35%, non-adherence 22%, and neurotoxicity 8% of patients. Of the 8 patients with CAN, 50% lost their graft, including one death with functioning graft and only 50% remained on therapy. Of the 15 patients converted to belatacept for all other indications, 93% remained on belatacept therapy. In addition 14/15 patients in the non-CAN group had a statistically significant increase in creatinine clearance at 6 months with average increase of 9ml/min/1.73m² (95% CI 1.8 to 16 ml/min/1.73m², p=0.018). In terms of safety, no infusion related adverse effects were noted and one patient reported cough. The only death was not related to belatacept administration.

Conclusions: Conversion to belatacept from CNI is well tolerated and resulted in improvement of allograft function in most patients without CAN. Based on our experience, patients with CAN are unlikely to see benefit from conversion to belatacept.

CITATION INFORMATION: Savic M, Cruz M, Rossi A, Vella J. Belatacept Conversion in Adult Kidney Transplant Recipients for Cause: A Single Center Observational Cohort. Am J Transplant. 2016;16 (suppl 3).

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