PURPOSE:

This is a retrospective look (08/2011-11/2014) on data collected from patients transplanted at Iowa Methodist Transplant Center.

METHODS:

All patients were EBV positive. They were induced with Simulect and maintained with Belatacept, Mycophenolate and Prednisone. Database collected recipient and donor demographics, kidney function, complications, and survival.

RESULTS:

Fifty eight patients, mean PRA 6, were started on de novo Belatacept. Most common HLA mismatch was 5. DGF was seen in 24%. Patients who continued on Belatacept maintained an average GFR of 65.

Belatacept was stopped in 16 patients of which BPAR was seen in 12 and BK in 2. Four of 12 patients experienced Banff IIB rejections. Patients were treated with Solumedrol +/- Thymoglobulin and maintained on a CNI based regimen. Rejections were seen earlier, typically at 1.5 months post-transplant and resolved with longer steroid taper. No grafts were lost to rejection. Average GFR after being treated for rejection was 54.

One kidney-after-lung recipient experienced severe TMA. Graft salvage and normalization of creatinine to 1.0 was possible with conversion to Belatacept. One patient developed PTLD after treatment of acute rejection with Thymoglobulin. BK viremia was seen in 15 patients. Most were treated with weaning Mycophenolate. Only 2 patients were converted off Belatacept to control the viremia. No grafts were lost to BK nephropathy.

CONCLUSIONS:

Belatacept is well tolerated and was only discontinued for treatment of rejection or BK. The acute rejection risk is similar to the BENEFIT trials. The PTLD risk is related to T cell depletion therapy. Advantages of using Belatacept de novo include better renal function and more favorable metabolic profile. This regimen simplifies post-transplant care. It eliminates the work involved with monitoring and managing drug levels during routine follow up care as well as in the management of DGF.

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