title: Belatacept-based, ATG-Fresenius-induction regimen for kidney transplant recipients: a proof-of-concept study.
abstract: Belatacept provides effective immunosuppression while avoiding the nephrotoxicities associated with calcineurin inhibitors (CNIs). However, existing belatacept-based regimens still have high rates of acute rejection. We hypothesized that therapy with belatacept, mycophenolic acid (MMA), steroids and induction therapy with rabbit anti-thymocyte globulin Fresenius (ATGF), rejection rate could be reduced. Prospective, single center, proof-of-concept study including males and females aged ≥18years, Epstein-Barr virus (EBV)-seropositive recipients of a first, HLA non-identical, live or deceased donor kidney allograft. Only patients with a calculated panel reactive antibody score of 0% were included. Three donors were positive for Chagas disease. Six of twelve patients had at least one infection and five were readmitted to the hospital for treatment. One patient had a Trypanosoma cruzi infection via the graft treated successfully. Median cold ischemia time for the transplant patients with a deceased donor was 21.5h. Mean serum creatinine levels at 1, 3 and 6months were 1.76±0.59, 1.55±0.60 and 1.49±0.60mg/dl, respectively. Two of twelve patients experienced clinical, biopsy-proven rejection, successfully treated with methylprednisolone. No patient developed post-transplant lymphoproliferative disorder (PTLD) or any other malignancy and no patient lost their graft or died during follow-up. The potential of this approach makes it worthy of further investigation.
authors.affiliation: Renal Transplantation, Hospital Alemán, Buenos Aires, Argentina; Foundation for Research and Assistance of Kidney Disease (FINAER), Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Cicora
authors.affiliation: Renal Transplantation, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Mos
authors.affiliation: Renal Transplantation, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: Jorgelina
authors.initials: J
authors.lastname: Petroni
authors.affiliation: Renal Transplantation, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: Matías
authors.initials: M
authors.lastname: Casanova
authors.affiliation: Renal Transplantation, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: Liliana
authors.initials: L
authors.lastname: Reniero
authors.affiliation: Foundation for Research and Assistance of Kidney Disease (FINAER), Buenos Aires, Argentina. Electronic address: javierroberti@gmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Roberti
mesh_terms: D000069594:Abatacept; D000328:Adult; D000368:Aged; D064591:Allografts; D000818:Animals; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D018796:Immunoconjugates / Q000008:administration & dosage*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011817:Rabbits
chemical_list: D000961:Antilymphocyte Serum; D018796:Immunoconjugates; D007166:Immunosuppressive Agents; D000069594:Abatacept
keywords: Antithymocyte globulin-Fresenius; Belatacept; Induction; Mycophenolate; Renal transplantation; Steroid