Conversion From Calcineurin Inhibitors to Belatacept in HLA-sensitized Kidney Transplant Recipients With Low-level Donor-specific Antibodies
Date
2019
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Article
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Abstract
Background: Belatacept could be the treatment of choice in renal-transplant recipients with renal dysfunction attributed to calcineurin inhibitor (CNI) nephrotoxicity. Few studies have described its use in patients with donor-specific antibody (DSA).
Methods: We retrospectively evaluated conversion from CNIs to belatacept in 29 human leukocyte antigen-immunized renal-transplant recipients. Data about acute rejection, DSA, and renal function were collected. These patients were compared with 42 nonimmunized patients treated with belatacept.
Results: Patients were converted from CNIs to belatacept a median of 444 days (interquartile range, 85-1200) after transplantation and were followed up after belatacept conversion, for a median of 308 days (interquartile range, 125-511). At conversion, 16 patients had DSA. Nineteen DSA were observed in these 16 patients, of which 11/19 were <1000 mean fluorescence intensity (MFI), 7/19 were between 1000 and 3000 MFI, and one was >3000 MFI. At last follow-up, preexisting DSA had decreased or stabilized. Seven patients still had DSA with a mean MFI of 1298 ± 930 at the last follow-up. No patient developed a de novo DSA in the DSA-positive group. In the nonimmunized group, one patient developed de novo DSA (A24-MFI 970; biopsy for cause did not show biopsy-proven acute rejection or microinflammation score). After belatacept conversion, one antibody-mediated rejection was diagnosed. The mean estimated glomerular filtration rate improved from 31.7 ± 14.2 mL/min/1.73 m to 40.7 ± 12.3 mL/min/1.73 m (P < 0.0001) at 12 months after conversion. We did not find any significant difference between groups in terms of renal function, proteinuria, or biopsy-proven acute rejection.
Conclusions: We report on a safe conversion to belatacept in human leukocyte antigen-immunized patients with low DSA levels.
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Citation
Ulloa CE, Anglicheau D, Snanoudj R, Scemla A, Martinez F, Timsit MO, Legendre C, Sberro-Soussan R. Conversion From Calcineurin Inhibitors to Belatacept in HLA-sensitized Kidney Transplant Recipients With Low-level Donor-specific Antibodies. Transplantation. 2019 Oct;103(10):2150-2156. doi:10.1097/TP.0000000000002592.
Keywords
Abatacept / administration & dosage, Calcineurin Inhibitors / administration & dosage, Calcineurin Inhibitors / adverse effects, Drug Substitution, Allografts / drug effects, Calcineurin Inhibitors / adverse effects, Glomerular Filtration Rate / drug effects, Glomerular Filtration Rate / immunology, Graft Rejection / drug therapy, Graft Rejection / immunology, Graft Rejection / pathology, HLA Antigens / immunology, Isoantibodies / blood, Isoantibodies / immunology, Isoantigens / immunology, Kidney / drug effects, Kidney / immunology, Kidney Transplantation / adverse effects, Renal Insufficiency / chemically induced, Renal Insufficiency / prevention & control