Effect of Belatacept on Late Acute Rejection Episodes and Graft Loss in Young Adults between the Ages of 18-24 Years: Post-Hoc Analysis of BENEFIT Study
Nephrology, Children National Health System, Washington, DC.
Meeting: 2018 American Transplant Congress
Abstract number: D289
Keywords: Age factors, Graft survival, Outcome, Rejection
Session Information
Session Name: Poster Session D: Late Breaking
Session Type: Poster Session
Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background: Recent data suggests higher incidence of late acute rejection (LAR) in young adults (18-24 years of age) causing graft loss just like adolescents due to non-adherence with immunosuppressive medications. Belatacept (BELA), an IV medication given once a month instead of oral calcineurin inhibitor may prevent LAR and graft loss in this vulnerable population due to improved adherence.
Methods: We carried out a post-hoc analysis of BENEFIT trial to assess the incidence of LAR (occurring after 6 months of transplant) in young adults in comparison to older adults (31-45 years) using Fisher exact test. BENEFIT trial was a phase 3 randomized trial comparing more-intensive (MI) BELA-based regimen, a less-intensive (LI) BELA based regimen to cyclosporine (CSA)-based regimen. These patients were followed up to 84 months. Based on this trial, LI BELA was FDA approved for clinical use. Therefore, amongst young adults, incidence of LAR, and time to graft loss was compared between LI BELA treated group to those treated with cyclosporine by Fisher exact test and Kaplan-Meier analysis respectively.
Results: There were 83 young adults (28 treated with MI BELA, 32 with LI BELA and 23 with CSA) and 180 older adults (57 received MI BELA, 67 LI BELA and 56 CSA). LAR occurred in 5 of 83 young adults vs. 2 of 180 older adults (p=0.033). Amongst young adults, 0 of 32 treated with LI BELA had LAR in comparison to 3 of 23 on CSA (P=0.06). Time to graft loss was not different in young adults receiving LI BELA versus those receiving CSA (p=0.751, HR 1.1.26 (0.318-3.993).
Conclusions: LAR occurs more commonly in the young adults compared to older adults regardless of treatment. LI BELA may prevent LAR in young adults but the study was underpowered to detect significant difference. Graft survival over 7 years follow up was not affected in young adults regardless of treatment with LI BELA or CSA.
CITATION INFORMATION: Moudgil A. Effect of Belatacept on Late Acute Rejection Episodes and Graft Loss in Young Adults between the Ages of 18-24 Years: Post-Hoc Analysis of BENEFIT Study Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Moudgil A. Effect of Belatacept on Late Acute Rejection Episodes and Graft Loss in Young Adults between the Ages of 18-24 Years: Post-Hoc Analysis of BENEFIT Study [abstract]. https://atcmeetingabstracts.com/abstract/effect-of-belatacept-on-late-acute-rejection-episodes-and-graft-loss-in-young-adults-between-the-ages-of-18-24-years-post-hoc-analysis-of-benefit-study/. Accessed May 9, 2025.« Back to 2018 American Transplant Congress