Long-Term Outcomes after Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant Recipients
Switching stable kidney-transplant recipients off calcineurin inhibitors to belatacept was linked to markedly better 7-year graft survival (78% vs 63%) with comparable rejection and safety, though more patients developed new proteinuria.
Background
Calcineurin inhibitors are the standard maintenance immunosuppression after kidney transplantation but are nephrotoxic and limit long-term graft survival; long-term evidence on belatacept conversion as an alternative had been lacking.
Study design
Prospective study of 311 kidney transplant recipients converted from calcineurin inhibitors to belatacept at two referral centers, with 243 optimally matched to 243 recipients maintained on calcineurin inhibitors; the primary endpoint was death-censored allograft survival at 7 years.
Key findings
At 7 years, allograft survival was 78% with belatacept versus 63% with calcineurin inhibitors (log-rank P<0.001). Rates of patient death, antibody-mediated and T-cell-mediated rejection, major cardiovascular events, and cancer were similar, but de novo proteinuria was more common with belatacept (37% vs 21%, P<0.001).
Clinical implications
These real-world data support conversion to belatacept as a calcineurin-inhibitor-avoidance strategy to preserve long-term graft function, while flagging increased proteinuria as a monitoring point. As a non-randomized cohort, residual confounding cannot be excluded.
Category
Transplant
Source
Clinical Journal of the American Society of Nephrology
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