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Late Conversion from Calcineurin Inhibitors to Belatacept in Kidney-Transplant Recipients Has a Significant Beneficial Impact on Glycemic Parameters

J. Noble, F. Terrec, T. Jouve, H. Neciri Bennani, P. Benhamou, P. Malvezzi, B. Janbon, D. Giovannini, L. Rostaing

Nephrology and Transplant Unit, CHU Grenoble, Grenoble, France

Meeting: 2020 American Transplant Congress

Abstract number: B-114

Keywords: Kidney transplantation, Metabolic complications

Session Information

Session Name: Poster Session B: Kidney Immunosuppression: Novel Regimens and Drug Minimization

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Calcineurin inhibitors (CNIs) and steroids are strongly associated with new-onset diabetes after transplantation (NODAT), worsening of pre-existing diabetes, and cardiovascular events. We assessed the benefit of conversion from CNI-based to belatacept-based immunosuppression in diabetic kidney-transplant (KT) recipients on glucose control and cardiovascular-risk factors.

*Methods: In this retrospective, non-controlled single-study conducted between May 2016 and October 26, 2018, we recruited KT recipients converted from CNIs to belatacept at least 6 months after KT. The primary endpoint was the evolution of HbA1c between baseline and after 6 months of treatment. Secondary endpoints included modifications to antidiabetic drugs, other cardiovascular risk factors, and renal function.

*Results: One hundred and three KT recipients were included. Of these, 26 (25%) had type-2 diabetes. The patients were either receiving oral antidiabetic drugs (n=21; 75%) or insulin-therapy (n=14; 54%). Overall HbA1c decreased significantly from 6.2±1 to 5.8 ± 1%, p < 0.0001. In diabetic patients, HbA1c decreased from 7.2±1 to 6.5 ± 1%, p=0.001. HbA1c significantly decreased in the subgroup of patients with new-onset diabetes at post transplantation and whether diabetes was controlled at inclusion or not (i.e., HA1c ≤7% or >7%). Moreover, no diabetic patient increased the number of oral anti-diabetic drugs and the dose of basal insulin was not statistically different from baseline to 6 months (16 UI at baseline and 16 UI at 6 months, p = 1). One patient had to start a treatment by insulin pump. During follow-up, the renal function, BMI and hemoglobin level of all 103 patients remained stable, two patients presented acute cellular rejection and no patient suffered from graft loss.

*Conclusions: A late switch from CNI to belatacept was a valuable therapeutic option for diabetic kidney recipients and substantially improved glycemic parameters.

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To cite this abstract in AMA style:

Noble J, Terrec F, Jouve T, Bennani HNeciri, Benhamou P, Malvezzi P, Janbon B, Giovannini D, Rostaing L. Late Conversion from Calcineurin Inhibitors to Belatacept in Kidney-Transplant Recipients Has a Significant Beneficial Impact on Glycemic Parameters [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/late-conversion-from-calcineurin-inhibitors-to-belatacept-in-kidney-transplant-recipients-has-a-significant-beneficial-impact-on-glycemic-parameters/. Accessed May 10, 2025.

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