Outcomes of De Novo Belatacept-Based Immunosuppression in Recipients of Kidneys at High Risk for Delayed Graft Function in the Setting of Lymphocyte Depleting Immune Modulation

T. L. Shertel¹, M. A. Wynd¹, M. A. Pereiras¹, J. T. McKeen¹, Y. Y. Yushkov², B. R. Schleich³, S. E. Geatrakas², A. Patel², M. J. Goldstein²

¹Pharmacy, Hackensack University Medical Center, Hackensack, NJ, ²Organ Transplant, Hackensack University Medical Center, Hackensack, NJ, ³Patient Safety and Quality, Hackensack University Medical Center, Hackensack, NJ

Meeting: 2020 American Transplant Congress

Abstract number: B-110

Keywords: Co-stimulation, Immunosuppression, Kidney transplantation, Renal function

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: Our center created an immunosuppression protocol using de novo belatacept (DNB) in the setting of lymphocyte depletion to increase the utilization of deceased donor kidneys at higher risk for delayed graft function (DGF) that would have been declined previously. The protocol was designed to reduce the nephrotoxic effects of calcineurin inhibitor (CNI)-based immunosuppression on the donor kidney with advanced donor or preservation-related injury. The experience of implementing this new protocol, potential side effects, and the early transplant results are described.

*Methods: A retrospective, observational study was performed on first time kidney transplant recipients treated with the DNB protocol from 10/1/2018 to 9/30/2019 (N=36). DNB protocol is defined as belatacept initiated within 7 days after transplant in patients receiving anti-thymocyte globulin induction therapy without concomitant CNIs.

Only adult patients who were EBV seropositive and received a deceased donor kidney at increased risk of DGF were included. Increased risk of DGF was defined as meeting one of the following criteria; anticipated cold ischemia time greater than 18 hours in cold static storage, donation after cardiac death, and donor-derived Stage 2 or 3 acute kidney injury.

*Results: The first 3-month follow-up for DGF, 30-day readmission, infections, adverse events and eGFR of the cohort are listed in Table 1. No patient had an acute rejection episode within 90 days of transplant. One patient died five weeks after transplant of a cardiac event with a functioning graft.

Table 1: DNB Performance and Adverse Event Summary
DGF	30 day Readmission	Median eGFR at 90 days	Leukopenia within 90 days	UTI within 90 days	BKV within 90 days	CMV within 90 days	Patient and Graft Survival
13/36 (36.11%)	11/36 (30.55%)	50.68	5/36 (13.89%)	5/36 (13.89%)	7/36 (19.44%)	1/36 (2.77%)	35/36 (97.22%)

*Conclusions: Three month outcomes with the DNB protocol are encouraging. Using DNB and avoiding CNIs is likely to promote utilization of kidneys at risk of DGF or being discarded. Longer term follow-up is necessary to assess further outcomes of the DNB protocol.

To cite this abstract in AMA style:

Shertel TL, Wynd MA, Pereiras MA, McKeen JT, Yushkov YY, Schleich BR, Geatrakas SE, Patel A, Goldstein MJ. Outcomes of De Novo Belatacept-Based Immunosuppression in Recipients of Kidneys at High Risk for Delayed Graft Function in the Setting of Lymphocyte Depleting Immune Modulation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-de-novo-belatacept-based-immunosuppression-in-recipients-of-kidneys-at-high-risk-for-delayed-graft-function-in-the-setting-of-lymphocyte-depleting-immune-modulation/. Accessed November 22, 2024.

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