Ulloa, CamiloAnglicheau, DanySnanoudj, RenaudScemla, AnneMartinez, FrankTimsit, Marc-OlivierLegendre, ChristopheSberro, Rebecca2022-07-052022-07-052019Ulloa 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.https://doi.org/10.1097/TP.0000000000002592http://hdl.handle.net/11447/6296Background: 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.enAbatacept / administration & dosageCalcineurin Inhibitors / administration & dosageCalcineurin Inhibitors / adverse effectsDrug SubstitutionAllografts / drug effectsCalcineurin Inhibitors / adverse effectsGlomerular Filtration Rate / drug effectsGlomerular Filtration Rate / immunologyGraft Rejection / drug therapyGraft Rejection / immunologyGraft Rejection / pathologyHLA Antigens / immunologyIsoantibodies / bloodIsoantibodies / immunologyIsoantigens / immunologyKidney / drug effectsKidney / immunologyKidney Transplantation / adverse effectsRenal Insufficiency / chemically inducedRenal Insufficiency / prevention & controlArticle