Introduction: Focal segmental glomerulosclerosis (FSGS) is a cause of end-stage renal failure that frequently recurs following renal transplant, often leading to allograft loss. A recently published case series demonstrated that abatacept (a biologic fusion protein that binds B7-1) could reverse proteinuria and podopathy in patients with recurrent FSGS after transplant. While abatacept is not clinically approved for transplant immunosuppression, belatacept (a closely related molecule possessing an even higher avidity for B7-1) is approved for this indication. We sought to determine whether immunosuppression regimens containing belatacept could prevent FSGS recurrence in renal transplant recipients. Additionally, as the original clinical trials of belatacept excluded recipients with FSGS, we evaluated the efficacy of belatacept in this patient population as manifested in rejection rates and long-term graft function. Methods: We present the outcomes of 65 consecutive renal transplant recipients with FSGS who were treated with belatacept, comparing them to 22 FSGS recipients treated with conventional tacrolimus-based immunosuppression regimens. All patients received basiliximab induction and well as mycophenolate mofetil and steroids. Mean follow-up was 1151 days (ranging from 69 to 2245 days). Kaplan-Meier survival curves were generated and significance determined by log-rank test. Results: There was a trend towards reduced incidence of recurrent FSGS in transplant recipients treated with belatacept compared to those receiving only tacrolimus, although statistical significance was not reached (7.8% vs. 21.7%, p= 0.12). There was no statistically significant change in the incidence of acute rejection, although belatacept protected against antibody-mediated rejection. Differences in estimated glomerular filtration rates over five years of follow-up were also statistically non-significant between the tacrolimus and belatacept-treated renal allograft recipients. Conclusions: This case series is the largest reported experience using belatacept in transplant recipients with FSGS. Belatacept administration appears safe in this patient population as manifested by equivalent rejection rates and graft function compared to tacrolimus. Furthermore, as suggested by earlier data with abatacept therapy, treatment with belatacept may potentially protect against recurrent FSGS in renal transplant recipients, although this must be validated in a larger study.

CITATION INFORMATION: Kitchens W, Farris A, Pastan S, Pearson T, Larsen C, Adams A. Focal Segmental Glomerulosclerosis Recurrence in Renal Transplant Recipients Treated with Belatacept. Am J Transplant. 2017;17 (suppl 3).

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