Session Time: 3:15pm-4:45pm
Presentation Time: 3:27pm-3:39pm
*Purpose: The introduction of belatacept costimulatory blockade therapy has added a novel and powerful agent to the immunosuppressive armamentarium utilized after renal transplantation. However, limited data are available regarding maintenance belatacept therapy and Polyoma BK viral infection after transplantation.
*Methods: Between 5/1/2016 and 11/30/2018, 149 renal transplants were performed at our institution. All patients were treated with Thymoglobulin induction therapy (4 mg/Kg). In 46 recipients maintenance immunosuppression consisted of monthly belatacept (5mg/Kg), starting on post operative day 7, low-dose tacrolimus (Tac)(target level of 3-5 ng/ml) and low-dose mycophenolate mofetil (MMF) 500 mg BID (Group A). Ninety-five recipients were treated and maintained on a triple therapy regimen consisting of low-dose MMF, low dose Tac and sirolimus (Group B). In 8 recipients for various indications belatacept therapy was introduced more than 5 months after transplantation and were excluded from this analysis. Monthly plasma screening by PCR for BK-viremia (BKV) was performed on all patients. BKV was defined by at least two positive plasma values of more than 1,000 copies/mL. BK nephropathy (PVAN) was defined by biopsy for cause.
*Results: Overall BKV was identified in 30 of the 141 Group A + Group B patients (21%). However, in Group A BKV developed in 16/46 patients (35%) compared to 14/95 Group B recipients (15%) p<0.05. The mean time to initial detection of BKV was 5 months in Group A (range 2-20 months) and 3 months in Group B (1-9 months).Overall PVAN was identified in 3/141 Group A and B patients (2%), and developed in 2 Group A patients (4%) and 1 Group B recipient (1%)
*Conclusions: The utilization of belatacept costimulation with low-dose Tac and MMF in Group A was associated with a significantly increased rate of BKV and a trend towards an increased rate of PVAN. Patients treated with maintenance belatacept warrant intense screening for BKV after transplant. Further and more detailed studies are needed to determine if this is directly related to costimulation blockade or due to an overall over-immunosuppressed state.
To cite this abstract in AMA style:Conti D, Maciera E, Pluckrose D, Garner M, Schuster D, Patel S. Maintenance Belatacept Therapy is Associated with Increased Rates of Polyoma Viremia [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/maintenance-belatacept-therapy-is-associated-with-increased-rates-of-polyoma-viremia/. Accessed October 21, 2020.
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