Conversion to Belatacept in Maintenance Kidney Transplant Patients

Abstract

The conversion to belatacept was effective, especially when performed early after transplantation.

Conversion to belatacept within 1‐year of renal transplantation in a diverse cohort including patients with donor‐specific antibodies

“…This suggests a continuous relationship between the duration of CNI exposure and accumulated irreversible endothelial dysfunction and that earlier CNI avoidance by means of conversion to belatacept may result in superior effects on allograft function. In the European experience from 5 transplant centers, conversion within 3 months was also associated with higher rates of BPAR (33.3% vs 4.3%; P < .01), although these patients received predominantly nondepleting induction therapies, and 1‐year allograft survival rates remained comparable to registry cohorts . In our cohort, timing of conversion to belatacept therapy was not associated with suboptimal allograft function among patients receiving rATG induction.…”

“…The results of our experience support a strategy of early conversion to belatacept for patients with a suitable clinical indication and suggest that conversion within the first year of transplant is associated with improved renal function and 1‐year allograft survival rates >90%. Other observational studies have suggested that conversion within 3 months of transplant results in greater eGFR improvement than later conversion, and conversion within 30 days of transplant may result in even greater eGFR benefit than conversion between 61 and 90 days . This suggests a continuous relationship between the duration of CNI exposure and accumulated irreversible endothelial dysfunction and that earlier CNI avoidance by means of conversion to belatacept may result in superior effects on allograft function.…”

“…Belatacept is a potentially favorable alternative to calcineurin inhibitors due to its renal safety, and its use has been associated with improved long‐term allograft function when compared with CNI maintenance . In the BENEFIT study, at 7‐years post‐transplant high‐ and moderate‐intensity de novo belatacept use was associated with an approximately 40% relative risk reduction in the rate of allograft loss as well as improved eGFR relative to cyclosporine .…”

“…In the landmark trial by Vincenti et al, a de novo CNI‐free regimen of belatacept, mycophenolate, and prednisone led to improved composite patient and allograft survival and a higher eGFR at 7‐years compared with a cyclosporine‐based regimen, despite higher rates of biopsy proven acute rejection (BPAR) with belatacept . Subsequent studies evaluated post‐transplant conversion from a CNI to belatacept and observed similar improvements in eGFR with belatacept relative to CNI maintenance, again with higher rates of early rejection …”

Belatacept-based immunosuppression: A calcineurin inhibitor-sparing regimen in heart transplant recipients

“…19 Similar results were reported in a recent retrospective multicenter European study, that showed a lower incidence of de novo DSA in BTC-treated kidney transplants. 20 CSA was discontinued in 50% of patients experiencing de novo DSA during BTC therapy. CSA discontinuation is associated with an increased incidence of Class II DSA.…”