Post-Transplant Reduction in Pre-Existing Donor-Specific Antibody Levels After Belatacept- vs Cyclosporine-Based Immunosuppression.

R. Bray,¹ H. Gebel,¹ R. Townsend,² M. Polinsky,² L. Yang,² U. Meier-Kriesche,² C. Larsen.¹

¹Emory University, Atlanta, GA
²Bristol-Myers Squibb, Lawrenceville, NJ

Meeting: 2017 American Transplant Congress

Abstract number: 169

Keywords: Antibodies, Donors, HLA antibodies, Kidney transplantation, marginal

Session Information

Session Name: Concurrent Session: Novel Immunosuppression - DSA Monitoring

Session Type: Concurrent Session

Date: Sunday, April 30, 2017

Session Time: 4:30pm-6:00pm

Presentation Time: 5:06pm-5:18pm

Location: E450b

Purpose: We explored the effect of belatacept (bela)- and cyclosporine (CsA)-based immunosuppression (IS) on pre-existing donor-specific antibody (DSA) levels by mean fluorescence intensity (MFI) in patients (pts) enrolled to BENEFIT and BENEFIT-EXT.

Methods: In both studies, T-cell–negative crossmatch kidney transplant recipients were randomized to bela more intense (MI)-, bela less intense (LI)-, or CsA-based IS. Pre-existing DSAs were assessed centrally at baseline via solid phase flow cytometry. Samples from DSA-positive pts were tested with Luminex single-antigen bead assays.

Results: In BENEFIT, pre-existing DSAs were detected in 4.6%, 4.9%, and 6.8% of pts randomized to bela MI, bela LI, and CsA, respectively. In BENEFIT-EXT, these values were 6.5%, 5.7%, and 9.2%, respectively. The HLA class distribution of DSAs by treatment arm was similar in each study.

BENEFIT

BENEFIT-EXT

Bela MI

(n=10)

Bela LI

(n=11)

CsA

(n=15)

Bela MI

(n=12)

Bela LI

(n=10)

CsA

(n=17)

Mean age, y

49.6

45.0

44.1

55.2

53.8

57.7

Antibody class, n (%)

Both

7 (70)

2 (20)

1 (10)

7 (64)

3 (27)

1 (9)

10 (67)

4 (27)

1 (7)

9 (75)

2 (17)

1 (8)

7 (70)

2 (20)

1 (10)

12 (71)

2 (12)

3 (18)

PRA, n (%)

<20%

≥20%

Missing

7 (70)

1 (10)

2 (20)

4 (36)

3 (27)

4 (36)

6 (40)

5 (33)

4 (27)

12 (100)

0 (0)

8 (80)

1 (10)

14 (82)

2 (12)

1 (6)

In both studies, more pts assigned to bela MI had baseline PRA <20% than ≥20%. Over the first 2 years, bela-treated pts exhibited greater decreases in DSA MFI vs CsA-treated pts. The effect of bela-based IS on DSA levels was more pronounced in BENEFIT-EXT vs BENEFIT. In both studies, MFI decline was more apparent with bela MI vs bela LI. Total IgG, IgM, and IgA levels were also reduced in bela-treated pts. Due to small sample sizes, clinical outcomes were not assessed.

Conclusions: Bela-based IS leads to greater decreases in DSA MFI in pts with pre-existing DSAs vs CsA-based IS.

CITATION INFORMATION: Bray R, Gebel H, Townsend R, Polinsky M, Yang L, Meier-Kriesche U, Larsen C. Post-Transplant Reduction in Pre-Existing Donor-Specific Antibody Levels After Belatacept- vs Cyclosporine-Based Immunosuppression. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Bray R, Gebel H, Townsend R, Polinsky M, Yang L, Meier-Kriesche U, Larsen C. Post-Transplant Reduction in Pre-Existing Donor-Specific Antibody Levels After Belatacept- vs Cyclosporine-Based Immunosuppression. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/post-transplant-reduction-in-pre-existing-donor-specific-antibody-levels-after-belatacept-vs-cyclosporine-based-immunosuppression/. Accessed November 21, 2024.

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