Long-Term Outcomes after Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant Recipients.
In a matched real-world cohort, conversion from calcineurin inhibitors to belatacept-based immunosuppression was associated with superior 7-year death-censored allograft survival and acceptable safety, at the cost of more de novo proteinuria.
Background
Conversion to belatacept is used as a calcineurin inhibitor (CNI) avoidance strategy when CNI-based standard-of-care immunosuppression is not tolerated after kidney transplantation. However, evidence on the long-term benefit and safety of conversion has been limited.
Study design
The investigators prospectively enrolled 311 kidney transplant recipients from 2007 to 2020 across two referral centres who were converted from CNI to belatacept per a prespecified protocol, then used optimal matching at the time of conversion to compare them with patients maintained on CNIs. After matching, 243 belatacept-converted patients were compared with 243 CNI controls, with well-balanced baseline characteristics; the primary endpoint was death-censored allograft survival at 7 years.
Key findings
At 7 years post-conversion, allograft survival was 78% in the belatacept group versus 63% in the CNI control group (P < 0.001 by log-rank). Rates of patient death (28% vs 36%), active antibody-mediated rejection (6% vs 7%), and T-cell-mediated rejection (4% vs 4%) were similar between groups, but de novo proteinuria was significantly more frequent with belatacept (37% vs 21%, P < 0.001).
Clinical implications
This real-world evidence suggests that post-transplant conversion to belatacept is associated with a lower risk of graft failure and acceptable safety compared with continued CNI therapy. Belatacept conversion may therefore be a valuable option for selected recipients, with attention to the higher rate of de novo proteinuria.
Category
Transplant
Source
Clin J Am Soc Nephrol
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