Abstract: TH-PO586
Belatacept Recovers Renal Allograft Function Despite Extensive Fibrosis
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Basu, Arpita, Mayo Clinic, Rochester, Rochester, Minnesota, United States
- Amer, Hatem, Mayo Clinic , Rochester, Minnesota, United States
- Alexander, Mariam P., Mayo Clinic, Rochester, Rochester, Minnesota, United States
Group or Team Name
- Mayo-Transplant Neph
Introduction
Prolonging kidney allograft lifespan is a complex problem despite advances in the field. Histological findings of fibrosis indicate irreversible injury, that increases with severity, ultimately resulting in graft loss. Good renal function despite severe fibrosis is a goal of therapy. We present 2 patients whose renal function improved with Belatacept in presence of substantial chronic damage.
Case Description
Patient 1:
46 year old male recipient of a deceased donor kidney. Received thymoglobulin induction and maintained on Tacrolimus, Mycophenolate Mofetil and Prednisone. Biopsy 1 week post transplant for poor renal function, showed significant fibrosis(Table1). Belatacept was substituted for Tacrolimus.He was liberated from dialysis 4 months later. Renal function continued to slowly improve over the years.
Patient 2:
35 year old lady received a living donor kidney. Immunosuppression similar to that of Patient 1. Three years post transplant, she was noted to have worsening renal function. Biopsy showed extensive chronic changes(Table1). Conversion to Belatacept led to gradual improvement in renal function.
Discussion
Belatcept’s renal sparing abilities improve renal function and can extend allograft survival despite severe chronic injury. The improvement is gradual occurring over several months to years, indicating a mechanism beyond the initial mitigation of the vasoconstrictive effects of Tacrolimus.
Table 1
| Time to Biopsy Post transplant(CrCl) | Banff Criteria |
| Patient 1: | |
| Time 0 (4ml/min) | g0, i0,t0, v0, cg0, ci1, ct1, cv3, mm0, ah2, ptc0, ti0 |
| 1 week (7ml/min-Belatacept initiated pos-transplant day 16) | g0, i0, t0, v0, cg0, ci3, ct3, cv3, mm0, ah3, ptc0, ti1, C4d0 |
| 1 year (38ml/min) | g0, i0,t0, v0, cg0, ci1, ct1, cv3, mm0, ah2, ptc0, ti0, C4d0 |
| 4 year (50.3ml/min) | g0, i0, t0, v0, cg0, ci1, ct1, cv3, mm0, ah2; ptc0, ti0, C4d0 |
| Patient 2 | |
| Time 0 (24ml/min) | g0, i0, , t0, v0, cg0, ci0, ct0, cv2, mm0,ah0, ptc0, ti0 |
| 1 year (87ml/min) | g0, i0, t0, v0, cg0, ci1, ct1, cv1, mm0, ah0, ptc0, ti0, C4d0 |
| 3 year (47ml/min- Belatacept initiated) | g0, i0, t0,v0, cg0, ci2, ct2, cv1, mm0,ah2, ptc0, ti2, C4d0 |
| 5 year (61ml/min) | g0, i0, t0, v0, cg0, ci2, ct2, cv1, mm0, ah2; ptc0, ti1, C4d0 |
Crcl: Creatinine Clearance in ml/min
Fig 1