title: Safe Conversion From Tacrolimus to Belatacept in High Immunologic Risk Kidney Transplant Recipients With Allograft Dysfunction.
abstract: There is no literature on the use of belatacept for sensitized patients or regrafts in kidney transplantation. We present our initial experience in high immunologic risk kidney transplant recipients who were converted from tacrolimus to belatacept for presumed acute calcineurin inhibitor (CNI) toxicity and/or interstitial fibrosis/tubular atrophy. Six (mean age = 40 years) patients were switched from tacrolimus to belatacept at a median of 4 months posttransplant. Renal function improved significantly from a peak mean estimated glomerular filtration rate (eGFR) of 23.8 ± 12.9 mL/min/1.73 m(2) prior to the switch to an eGFR of 42 ± 12.5 mL/min/1.73 m(2) (p = 0.03) at a mean follow-up of 16.5 months postconversion. No new rejection episodes were diagnosed despite a prior history of rejection in 2/6 (33%) patients. Surveillance biopsies performed in 5/6 patients did not show subclinical rejection. No development of donor-specific antibodies (DSA) was noted. In this preliminary investigation, we report improved kidney function without a concurrent increase in risk of rejection and DSA in six sensitized patients converted from tacrolimus to belatacept. Improvement in renal function was noted even in patients with chronic allograft fibrosis without evidence of acute CNI toxicity. Further studies with protocol biopsies are needed to ensure safety and wider applicability of this approach.
authors.affiliation: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: G
authors.initials: G
authors.lastname: Gupta
authors.affiliation: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: A
authors.initials: A
authors.lastname: Regmi
authors.affiliation: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: D
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: S
authors.initials: S
authors.lastname: Posner
authors.affiliation: Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: M P
authors.initials: MP
authors.lastname: Posner
authors.affiliation: Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: A
authors.initials: A
authors.lastname: Cotterell
authors.affiliation: Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: C S
authors.initials: CS
authors.lastname: Bhati
authors.affiliation: Division of Transplant Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: P
authors.initials: P
authors.lastname: Kimball
authors.affiliation: Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: H D
authors.initials: HD
authors.lastname: Massey
authors.affiliation: Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: A L
authors.initials: AL
authors.lastname: King
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D064591:Allografts / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced*; D051437:Renal Insufficiency / Q000139:chemically induced*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000069594:Abatacept; D016559:Tacrolimus
keywords: Calcineurin inhibitor (CNI); fusion proteins and monoclonal antibodies: belatacept, drug toxicity, immunosuppressant; immunosuppressant; interstitial fibrosis and tubular atrophy; sensitization