Renal Preservation with Belatacept-Based versus Everolimus-Based Immunosuppression in Lung Transplant Recipients

E. Sartain¹, K. Schoeppler¹, B. Crowther¹, J. Smith², A. Gray²

¹University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, ²Department of Medicine, Division of Pulmonary Sciences and Critical Care, University of Colorado, Denver, CO

Meeting: 2021 American Transplant Congress

Abstract number: 191

Keywords: Co-stimulation, Lung, Rapamycin, Renal function

Topic: Clinical Science » Lung » Lung: All Topics

Session Information

Session Name: When Opportunity Knocks... Identifying Interventions to Optimize Lung Transplant Outcomes

Session Type: Rapid Fire Oral Abstract

Date: Sunday, June 6, 2021

Session Time: 6:00pm-7:00pm

Presentation Time: 6:10pm-6:15pm

Location: Virtual

*Purpose: Renal dysfunction is one of the most common long-term complications among lung transplant recipients (LTRs). Calcineurin-inhibitor (CNI) nephrotoxicity is a recognized contributor to renal insufficiency. CNI-minimization strategies using belatacept (BELA) based immunosuppressive regimens have not been as established in LTRs as everolimus (EVR) based immunosuppressive regimens. We sought to compare the impact of these two CNI sparing strategies on renal function in LTRs.

*Methods: This retrospective analysis compared LTRs on BELA to those on EVR between 1/2012 and 9/2020. Patients maintained on therapy at least 3 months were eligible for inclusion. Primary outcome was change in eGFR at 6 months. Secondary outcomes at 6 months included change in FEV1, biopsy-proven acute rejection (BPAR), cytomegalovirus infection, fungal infection, de novo donor-specific antibody formation, post-transplant diabetes mellitus, and change in triglyceride level.

*Results: Seventy-three patients were analyzed (14 BELA, 59 EVR). CNI minimization was used in the majority of patients on BELA or EVR. Baseline characteristics were similar between BELA and EVR, including pre-transplant eGFR, diabetes mellitus, and hypertension as well as renal failure during transplant hospitalization (Table 1). Tacrolimus levels were significantly lower at 3 and 6 months in the EVR group. On average, both strategies were associated with numerical improvement in eGFR at 6 months (BELA +6 mL/min/1.73m² , p=0.11; EVR +3 mL/min/1.73m² , p=0.04). There was no significant difference when change in eGFR was compared between groups (p=0.62). Secondary outcomes were similar, however there was a trend toward increased triglyceride levels in the EVR cohort (Table 2).

*Conclusions: To our knowledge, this is the first study to compare BELA and EVR as renal-sparing strategies among LTRs. A BELA-based strategy appears to result in similar renal effects to EVR, despite significantly higher tacrolimus levels, without increased risk of BPAR at 6 months. Larger studies with longer term follow up are needed to understand the impact on lung function, CLAD rates and infection risks with these two regimens.

To cite this abstract in AMA style:

Sartain E, Schoeppler K, Crowther B, Smith J, Gray A. Renal Preservation with Belatacept-Based versus Everolimus-Based Immunosuppression in Lung Transplant Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-preservation-with-belatacept-based-versus-everolimus-based-immunosuppression-in-lung-transplant-recipients/. Accessed May 16, 2025.

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