title: Effect of an Early Switch to Belatacept Among Calcineurin Inhibitor-Intolerant Graft Recipients of Kidneys From Extended-Criteria Donors.
abstract: Transplant recipients receiving a kidney from an extended-criteria donor (ECD) are exposed to calcineurin inhibitor (CNI) nephrotoxicity, as demonstrated by severe delayed graft function and/or a low GFR. Belatacept is a nonnephrotoxic drug that is indicated as an alternative to CNIs. We reported 25 cases of conversion from a CNI to belatacept due to CNI intolerance within the first 6 mo after transplantation. The mean age of the recipients was 59 years, and 24 of 25 patients received ECD kidneys. At the date of the medication switch, 12 of 25 patients displayed a calculated GFR (cGFR) <15 mL/min, six patients remained on dialysis, and the biopsies showed evidence of acute tubular damage associated with severe vascular or tubulointerstitial chronic lesions. Three patients did not recover renal function, and three patients died during the follow-up period. Among the remaining patients, renal function improved: The cGFR was 18.28 ± 12.3 mL/min before the medication switch compared with 34.9 ± 14.5 mL/min at 1 year after conversion to belatacept (p = 0.002). Tolerance of and compliance with belatacept were good, and only one patient experienced acute rejection. Belatacept is an effective therapy that preserves renal function in kidney transplant patients who are intolerant of CNIs.
authors.affiliation: Department of Nephrology and Transplantation, University Hospital La Cavale Blanche, European University of Brittany, Brest, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Le Meur
authors.affiliation: Department of Renal Transplantation, Necker-Enfants Malades University Hospital, AP-HP, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Aulagnon
authors.affiliation: Department of Nephrology, University Hospital, Rouen, France.
authors.forename: D
authors.initials: D
authors.lastname: Bertrand
authors.affiliation: Department of Nephrology, University Hospital, Clermont-Ferrand, France.
authors.forename: A E
authors.initials: AE
authors.lastname: Heng
authors.affiliation: Department of Nephrology and Transplantation, University Hospital, Reims, France.
authors.forename: S
authors.initials: S
authors.lastname: Lavaud
authors.affiliation: Department of Nephrology and Renal Transplantation, Hospices Civils, Strasbourg, France.
authors.forename: S
authors.initials: S
authors.lastname: Caillard
authors.affiliation: Department of Nephrology and Clinical Immunology-EA4245, Bretonneau Hospital, University Hospital, Tours, France.
authors.forename: H
authors.initials: H
authors.lastname: Longuet
authors.affiliation: Department of Renal Transplantation, Necker-Enfants Malades University Hospital, AP-HP, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Sberro-Soussan
authors.affiliation: Department of Anatomy and Pathology, University Hospital, Brest, France.
authors.forename: L
authors.initials: L
authors.lastname: Doucet
authors.affiliation: Department of Nephrology and Transplantation, University Hospital La Cavale Blanche, European University of Brittany, Brest, France.
authors.forename: A
authors.initials: A
authors.lastname: Grall
authors.affiliation: Department of Renal Transplantation, Necker-Enfants Malades University Hospital, AP-HP, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Legendre
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D000368:Aged; D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D051799:Delayed Graft Function / Q000188:drug therapy / Q000209:etiology; D004351:Drug Resistance / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000069594:Abatacept
keywords: clinical research/practice; delayed graft function (DGF); donors and donation: extended criteria; drug toxicity; fusion proteins and monoclonal antibodies: adhesion molecule specific; immunosuppressant; immunosuppression/immune modulation; kidney (allograft) function/dysfunction; kidney transplantation/nephrology