Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Belatacept is a recombinant soluble fusion protein which selectively blocks T-cell co-stimulation. It received initial FDA approval for prophylaxis of organ rejection in Epstein-Barr virus seropositive kidney transplant recipients. Use of belatacept for prophylaxis of rejection in other transplanted organs has not been well established. Data from a limited number of small studies suggest a possible role of belatacept among lung transplant recipients (LTR).
*Methods: We report a case series on the use of belatacept in LTRs at a single comprehensive transplant center. Descriptive statistics were used to describe patient characteristics and univariate nonparametric statistical tests were used to assess differences before and after belatacept.
*Results: A total of twenty-three patients received belatacept as a calcineurin inhibitor (CNI) sparing or dose reducing strategy. Four patients were initiated on belatacept-based immunosuppression regimen (ISR) immediately after LT due to pre-lung transplant renal impairment. Indications for belatacept included CNI-associated renal impairment in 10/23 (43%) LTRs, CNI-associated thrombotic microangiopathy in 3/23 (13%) LTRs, CNI-associated stroke in 2/23 (7%) LTRs, and CNI-associated posterior reversible encephalopathy syndrome in 4/23 (17%) LTRs. Within the two-year study period, 15/23 (65%) LTRs were transitioned back to CNI or had addition of CNI to their ISR. Statistically significant increase in mean glomerular filtration rate (GFR) was seen in all patients with pre-belatacept mean GFR 52ml-min/m2 versus post-belatacept mean GFR 85ml-min/m2, p < 0.001 using two tailed Man Whitney U. All five patients who needed post-operative dialysis were liberated from dialysis at discharge and remained dialysis free throughout the 2-year study period. No patients experienced belatacept-treatment limiting adverse events or cellular rejection (average CRSS while on belatacept = 0.184). Fifteen positive bronchoalveolar lavage cultures were identified, consisting of 4/15 (27%) gram positive cultures and 11/15 (73%) gram negative cultures. Four patients died while on belatacept attributed to chronic lung allograft dysfunction in 3/4 (75%) LTRs and multiorgan system failure in the fourth patient.
*Conclusions: Belatacept-based ISRs seems to be a reasonable option for LTRs with contraindication to or intolerance to CNI. Larger trials are needed to establish the effectiveness of belatacept in LTRs.
To cite this abstract in AMA style:Patel H, Ensor CR, Davis RD, Bogar L, Colella D, Kildea M, Kim J, Satterthwaite A, Ventura D, Gries C. Case Series of Belatacept for Calcineurin Inhibitor Sparing after Lung Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/case-series-of-belatacept-for-calcineurin-inhibitor-sparing-after-lung-transplantation/. Accessed March 6, 2021.
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