title: Early post-transplant conversion from tacrolimus to belatacept for prolonged delayed graft function improves renal function in kidney transplant recipients.
abstract: Prolonged delayed graft function (DGF) in kidney transplant recipients imparts a risk of poor allograft function; tacrolimus may be detrimental in this setting. We conducted a retrospective single center analysis of the first 20 patients converted to belatacept for prolonged DGF as part of a clinical protocol as a novel treatment strategy to treat prolonged DGF. Prior to conversion, patients underwent an allograft biopsy to rule out rejection and confirm tubular injury. The primary outcome was the estimated glomerular filtration rate (eGFR) at 12 months post-transplant; secondary outcome was the change in eGFR 30 days post-belatacept conversion. At 1 year post-transplant, the mean eGFR was 54.2 (SD 19.2) mL/min/1.73 m2. The mean eGFR on the day of belatacept conversion was 16 (SD 12.7) mL/min/1.73 m2and rose to 43.1 (SD 15.8) mL/min/1.73 m230 days post-conversion (P<.0001). The acute rejection rate was 20% with 100% patient survival at 12 months post-transplant. There was one graft loss in the setting of an invasive Aspergillus infection that resulted in withdrawal of immunosuppression and transplant nephrectomy. Belatacept conversion for prolonged DGF is a novel treatment strategy that resulted in an improvement in eGFR. Additional follow-up is warranted to confirm the long-term benefits of this strategy.
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David
authors.identifier: 0000-0001-5342-0277
authors.initials: D
authors.lastname: Wojciechowski
authors.affiliation: Division of Nephrology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Sindhu
authors.initials: S
authors.lastname: Chandran
authors.affiliation: Division of Nephrology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Flavio
authors.initials: F
authors.lastname: Vincenti
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D051799:Delayed Graft Function / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology; D006085:Graft Survival; 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; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D000069594:Abatacept; D016559:Tacrolimus
keywords: belatacept; delayed graft function; kidney transplant