Belatacept Versus Tacrolimus for Kidney Transplant Recipients of Deceased Donors With Acute Kidney Injury: US National Database Study
Among recipients of deceased-donor kidneys affected by acute kidney injury, starting belatacept instead of tacrolimus gave slightly better early kidney function but a higher early rejection rate, with no difference in patient or graft survival.
Study design
Using the US Organ Procurement and Transplantation Network database, the authors created 1:4 matched cohorts of recipients of deceased-donor kidneys with acute kidney injury, comparing 567 patients started on belatacept against 2,268 started on tacrolimus for initial maintenance immunosuppression, with follow-up of about 3 years.
Key findings
Estimated GFR was significantly higher with belatacept at 6 months (58.2 vs 54.6 mL/min/1.73 m2) but the difference was no longer significant at 12 months (57.2 vs 55.7). There were no significant differences in mortality (HR 1.18, 95% CI 0.95-1.47) or death-censored graft failure (HR 1.17). Rejection within 12 months was significantly more common with belatacept (13% vs 7%).
Clinical implications
For AKI-donor kidneys, belatacept offered only a transient early functional benefit at the cost of more early rejection, without improving survival, suggesting it should not replace tacrolimus by default in this population. As a retrospective registry study, residual confounding limits causal inference.
Category
Transplant
Source
Transplantation
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