De-Novo Belatacept Therapy is Associated with Higher Levels of BK Viremia and Lower Rates of BK Clearance in Kidney Transplantation Patients
1Albany Medical Center, Albany, NY, 2Division of Renal and Pancreatic Transplant Services, Albany Medical Center, Albany, NY, 3George Mason University, Fairfax, VA, 4UMC Las Vegas, Las Vegas, NV
Meeting: 2022 American Transplant Congress
Abstract number: 1693
Keywords: Polyma virus
Topic: Clinical Science » Kidney » 38 - Kidney Immunosuppression: Novel Regimens and Drug Minimization
Session Information
Session Name: Kidney Immunosuppression: Novel Regimens and Drug Minimization
Session Type: Poster Abstract
Date: Tuesday, June 7, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
Session Information
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Hall C
*Purpose: To compare the incidence and severity of BK viremia in kidney transplantation patients with a de-novo belatacept (bela) vs. a no-bela maintenance immunosuppression regimen.
*Methods: Patients who underwent kidney transplantation at one academic medical center between 2015 to 2021 were divided into two groups based on maintenance immunosuppression regimens: standard dose mycophenolate, rapamune, and tacrolimus vs. low-dose mycophenolate, low-dose tacrolimus, and belatacept (5.0 mg/kg monthly). Serum BK polyoma PCR was obtained monthly and continued for two years or until establishing viral clearance following transplantation. BK viremia was defined as a PCR level >3,000 copies/mL. The severity of BK viremia was stratified based on maximum quantified levels of >5,000 and >10,000 copies/mL. Time intervals from transplantation to BK viremia and the incidence of acute rejection within the first 12 months following transplant was also assessed.
*Results: 246 no bela vs. 119 de-novo bela patients were identified. There was a significant difference in the incidence of BK viremia between bela and no bela treatment groups (28.6% vs. 16.7%, respectively, p=.01). Bela treatment was also associated with significantly higher maximum quantified levels of >5,000 (bela 25.2% vs. no bela 14.6%, p=.02) and >10,000 (bela 21.8% vs. no bela 13%, p=.04). The time interval from transplantation to viremia was similar between groups (mean days: bela 167 vs. no bela 213, p=.30). Patients receiving bela were less likely to achieve clearance of BK viremia when compared with no bela (21.6% vs. 72.6%, respectively, p<.001). Acute rejection within 12 months of transplantation was similar between bela (2.6%) and no bela (2.3%).
*Conclusions: Recently there has been increased utilization of belatacept for long-term maintenance immunosuppression following kidney transplantation. However, data regarding the risk of post-transplant BK viremia in de-novo belatacept patients is limited. Our data shows that de-novo belatacept treatment is associated with a significantly greater incidence of BK viremia despite similar rates of treatment for acute rejection. Additionally, belatacept treatment was associated with higher maximum BK titers, and a lower likelihood of complete viremia clearance. Therefore, belatacept treatment may necessitate more vigilant post-operative BK surveillance and immunosuppression tapering at the onset of BK viremia diagnosis.
To cite this abstract in AMA style:
Petrossian G, Ortiz J, Addonizio K, Teixeira L, Hsiao A, James R, Koizumi N, Patel S, Conti D, Plews R. De-Novo Belatacept Therapy is Associated with Higher Levels of BK Viremia and Lower Rates of BK Clearance in Kidney Transplantation Patients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/de-novo-belatacept-therapy-is-associated-with-higher-levels-of-bk-viremia-and-lower-rates-of-bk-clearance-in-kidney-transplantation-patients/. Accessed May 11, 2025.« Back to 2022 American Transplant Congress