title: Experience with belatacept rescue therapy in kidney transplant recipients.
abstract: In kidney transplant recipients with chronic graft dysfunction, long-term immunosuppression with calcineurin inhibitors (CNIs) or mTOR inhibitors (mTORi) can be challenging due to adverse effects, such as nephrotoxicity and proteinuria. Seventy-nine kidney transplant recipients treated with CNI-based or mTORi-based maintenance immunosuppression who had CNI-induced nephrotoxicity or severe adverse events were switched to belatacept. Mean time from transplantation to belatacept conversion was 69.0 months. Mean estimated glomerular filtration rate (eGFR) ± standard deviation at baseline was 26.1 ± 15.0 ml/min/1.73 m2, increasing to 34.0 ± 15.2 ml/min/1.73 m2at 12 months postconversion (P < 0.0005). Renal function improvements were also seen in patients with low eGFR (<25 ml/min/1.73 m2) or high proteinuria (>500 mg/l) at conversion. The Kaplan-Meier estimates for patient and graft survival at 12 months were 95.0% and 85.6%, respectively. The discontinuation rate due to adverse events was 7.9%. One case of post-transplant lymphoproliferative disorder occurred at 17 months postconversion. For comparison, a historical control group of 41 patients converted to mTORi-based immunosuppression because of biopsy-confirmed CNI-induced toxicity was examined; eGFR increased from 27.6 ± 7.2 ml/min/1.73 m2at baseline to 31.1 ± 11.9 ml/min/1.73 m2at 12 months (P = 0.018). Belatacept-based immunosuppression may be an alternative regimen for kidney transplant recipients with CNI- or mTORi-induced toxicity.
authors: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany. Susanne.Brakemeier@charite.de.
authors: Susanne
authors: S
authors: Brakemeier
authors: Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Erlangen, Germany.
authors: Dennis
authors: D
authors: Kannenkeril
authors: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
authors: Michael
authors: M
authors: Dürr
authors: Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Erlangen, Germany.
authors: Tobias
authors: T
authors: Braun
authors: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
authors: Friederike
authors: F
authors: Bachmann
authors: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
authors: Danilo
authors: D
authors: Schmidt
authors: Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Erlangen, Germany.
authors: Michael
authors: M
authors: Wiesener
authors: Division of Nephrology, Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
authors: Klemens
authors: K
authors: Budde
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001706:Biopsy; D065095:Calcineurin Inhibitors / Q000494:pharmacology; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000401:mortality; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000276:immunology; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000069594:Abatacept
keywords: belatacept; calcineurin inhibitor; conversion; kidney transplantation; mTOR inhibitor