Pill Burden in Belatacept versus Tacrolimus-Based Immunosuppression
Emory Healthcare, Atlanta, GA
Meeting: 2021 American Transplant Congress
Abstract number: 950
Keywords: Immunosuppression, Kidney, Quality of life
Topic: Clinical Science » Kidney » Kidney Living Donor: Long Term Outcomes
Session Information
Session Name: Kidney Living Donor: Long Term Outcomes
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: Medication non-adherence is a major barrier amongst renal transplant recipients, and improvement can be seen after reduction in pill burden. Belatacept versus tacrolimus-based immunosuppression has shown renal preservation and improved cardiovascular and metabolic outcomes. We aimed to compare the daily pill burden in patients on belatacept versus tacrolimus-based regimens.
*Methods: We performed a single center retrospective analysis of kidney transplant recipients who were transplanted January 2017 through January 2019. Patients with failed allograft, death, or <1 year of follow-up were excluded from the study. Using t-tests and ANOVA, we compared 4 groups based on immunosuppression regimen: belatacept, tacrolimus, tacrolimus to belatacept conversion, and belatacept to tacrolimus conversion.
*Results: 432 patients were included in this study: belatacept (n=74), tacrolimus (n=330), conversion to belatacept (n=21), and conversion to tacrolimus (n=7). All groups were similar in demographics. (TABLE1). The number of oral medications and daily pill burden at discharge was similar across all groups. A significant reduction in number of medications [Median 8 (IQR 6-11) pills, p 0.001] and pill burden [Median 11(IQR 9-15) pills, p<<0.001] was observed amongst recipients on belatacept. A reduction in number of medications [Median 7(IQR 5-9) pills, p 0.001] and daily pill burden [Median 11 (IQR 7-15) pills, p<0.001] was also observed in patients converted from tacrolimus to belatacept. Reduction in pill burden in betalacept groups was seen even if stratified by age group (Table 2).
TABLE 1.Characteristics by immunosuppression protocol
| Total N=432 | Belatacept (n=74) | Tacrolimus (n=330) | Conversion to belatacept (n=21) | Conversion to tacrolimus (n=7) | p-value |
| Median Age (IQR) | 53(43-60) | 51(42-59) | 46(38-66) | 50(40-58) | 0.67 |
| Male (%) | 41 | 196 | 2 | 15 | 0.37 |
| Black (%) | 38 | 176 | 3 | 11 | 0.45 |
| Time to Follow up(IQR) | 22(18-38) | 28(24-34) | 29(23-35) | 35(23-37) | 0.25 |
| Post-transplant | |||||
| Median Number or medications | 12(10-13) | 12(10-13) | 11(9-13) | 13(11-14) | 0.16 |
| Daily Pill Burden | 19(16-23) | 21(17-25) | 18(15-22) | 18(17-23) | 0.03 |
| At last visit | |||||
| Median Number or medications | 8(6-11) | 10(8-12) | 7(5-9) | 11(10-13) | 0.001 |
| Daily Pill Burden | 11(9-15) | 17(13-20) | 11(7-15) | 22(17-28) | <0.001 |
TABLE 2. Pill burden at follow up by age (IQR)
| Belatacept | Tacrolimus | Conversion to belatacept | Conversion to tacrolimus | p-value | |
| <40 yrs | 10 (6-11) | 15 (11-18) | 15 (10-17) | 22 (18-25) | 0.003 |
| 40-60 yrs | 12 (10-15) | 17 (13-21) | 9 (7-14) | 16 (12-19) | <0.001 |
| >60 yrs | 13 (11-18) | 17 (14-22) | 13 (12-14) | 27 (24-29) | 0.005 |
*Conclusions: Belatacept should be the immunosuppression of choice amongst all eligible kidney transplant recipients to reduce pill burden and potentially improve medication adherence.
To cite this abstract in AMA style:
Gattis S, Lakhani L, Basu A. Pill Burden in Belatacept versus Tacrolimus-Based Immunosuppression [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/pill-burden-in-belatacept-versus-tacrolimus-based-immunosuppression/. Accessed May 16, 2025.« Back to 2021 American Transplant Congress