title: Belatacept-versus cyclosporine-based immunosuppression in renal transplant recipients with pre-existing diabetes.
abstract: OBJECTIVE
  Renal transplant recipients with pre-existing diabetes (PD) have reduced graft survival and increased risk of mortality and ischemic heart disease compared with nondiabetic transplant recipients. To assess the effect of belatacept in this high-risk group, we evaluated outcomes of the subpopulation with PD from previously published BENEFIT and BENEFIT-EXT trials.
  
  
  METHODS
  A post hoc analysis evaluated pooled data from BENEFIT (living donors or standard criteria donors) and BENEFIT-EXT (extended criteria donors). Patients were randomized to receive cyclosporine or a more intensive (MI) or less intensive (LI) belatacept regimen.
  
  
  RESULTS
  Of 1209 intent-to-treat patients, 336 had PD. At 12 months, the belatacept LI arm demonstrated a numerically higher rate of patients surviving with a functioning graft (90.4% MI [103 of 114], 92.8% LI [90 of 97], and 80.8% cyclosporine [101 of 125]), and fewer serious adverse events than cyclosporine or MI patients. Three cases of posttransplant lymphoproliferative disorder were reported in LI patients, one involving the central nervous system. Higher rates (% [95% confidence interval]: 22.8% MI [15.1 to 30.5]; 20.6% LI [12.6 to 28.7]; 14.4% cyclosporine (8.2 to 20.6]) and grades of acute rejection were observed with belatacept. Measured GFR (ml/min per 1.73 m(2), 59.8 MI; 62.5 LI; 45.4 cyclosporine), and cardiovascular risk profile were better for belatacept versus cyclosporine.
  
  
  CONCLUSIONS
  In post hoc analysis of patients with PD, patient/graft survival and renal function at 12 months were numerically higher with belatacept versus cyclosporine, but not statistically significant. Further study is necessary to confirm the benefits belatacept may provide in these patients.
authors.affiliation: Department of Nephrology, Dialysis and Multiorgan Transplantation, University Hospital, Toulouse, France. rostaing.l@chu-toulouse.fr
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.forename: Hans H
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Rafael
authors.initials: R
authors.lastname: Reyes-Acevedo
authors.forename: Barbara
authors.initials: B
authors.lastname: Bresnahan
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Stefan
authors.initials: S
authors.lastname: Vitko
authors.forename: Michael
authors.initials: M
authors.lastname: Heifets
authors.forename: Jun
authors.initials: J
authors.lastname: Xing
authors.forename: Dolca
authors.initials: D
authors.lastname: Thomas
authors.forename: Flavio
authors.initials: F
authors.lastname: Vincenti
mesh_terms: D000069594:Abatacept; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D048909:Diabetes Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D018796:Immunoconjugates / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018796:Immunoconjugates; D007166:Immunosuppressive Agents; D000069594:Abatacept; D016572:Cyclosporine