Session Time: 6:00pm-7:00pm
Presentation Time: 6:20pm-6:25pm
*Purpose: The costimulatory inhibitor, belatacept (Bela) has been shown to be an effective alternative in several clinical situations including calcineurin toxicity, de novo alloantibody formation and thrombotic microscopic angiopathy. In order to further explore the usefulness of Bela under various clinical scenarios, we performed a retrospective analysis of a prospective database of all recipients who were converted to betatacept maintenance immunosuppression regimen after kidney transplantation.
*Methods: This single center study reviewed the electronic records of all patients who received a KT between 2016 and 2020. A total of 57 patients were converted to Bela. Of these recipients, 25 (43.8%) converted within the first 6 months and 32 (56.2%) converted after 6 months. The indications for conversion were: calcineurin inhibitor (CNI) toxicity (26.3%), thrombotic microangiopathy (8.8%), de novo DSA (36.8%), chronic antibody rejection (AMR) with or without significant fibrosis (IFTA) (28.1%).
*Results: Early conversion significantly improved GFR at 3, 6- and 12-months post-conversion. However, late conversion has no effect on GFR . Thirty four (59.63%) patients were converted Bela, mycophenolate and steroids and 23 (40.4%) converted to Bela, low dose CNI and steroids. Only 6 patients (10.5%) developed rejection after conversion, 5 (83.4%) in early conversion group. Five patients (83.4%) had T cell mediated cellular rejection and one patient (16.6%) had acute antibody mediated rejection. The rejection rate was 14.7% in group of belatacept without CNI compared to 4.3% in the group on belatacept with low dose CNI (p<0.001). All patients with chronic AMR±IFTA were in late conversion group (59.2%) which led to stabilization in their GFR (32 vs 30 mL/min) at 1 year post conversion. Out of 21 patients who were converted to belatacept due to de-novoDSA, 9 (42.9%) patients had complete or partial resolution of DSA. Interestingly, in early conversion group 80% responded vs (31.2%) in late conversion group (P<0.001)
*Conclusions: The conversion to belatacept was effective, especially when performed early after kidney transplantation. Late conversion to belatacept was beneficiary for a subgroup of patients with chronic changes.
To cite this abstract in AMA style:Saidi R, Huang N, Yang C, Movileanu I, Ecal K, Senay A, Pankewycz O, Dvorai R, Shahbazov R, Laftavi M. Conversion to Belatacept Based Immunosuppression Regimen in Kidney Transplant Patients: Lessons Learned [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/conversion-to-belatacept-based-immunosuppression-regimen-in-kidney-transplant-patients-lessons-learned/. Accessed July 30, 2021.
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