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Kidney Week

Abstract: FR-PO1189

Outcomes of Kidney Allograft Function in a Patient with Thrombotic Microangiopathy Switched to Co-Stimulation Blocking Agent (Belatacept)

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Elharrif, Khalid M., University of Texas Medical Branch, Galveston, Texas, United States
  • Gamilla-Crudo, Ann Kathleen N., University of Texas Medical Branch, Galveston, Texas, United States
  • Hussain, Syed A., University of Texas Medical Branch, Galveston, Texas, United States
  • Ramirez, Regina L., UTMB Health, Galveston, Texas, United States
  • Abifaraj, Farah, University of Texas Medical Branch, Galveston, Texas, United States
  • Mujtaba, Muhammad Ahmad, University of Texas Medical Branch, Galveston, Texas, United States
Background

Thrombotic microangiopathy (TMA) is a severe complication of kidney transplantation. TMA may occur de novo or as recurrent disease post transplantation. De novo disease is usually associated with immunosuppressive drugs [calcineurin inhibitors (CNI’s) and sirolimus] or can be seen as a part of endothelial damage that accompanies antibody-mediated rejection (AMR). Treatment for de novo TMA is limited to plasma exchange and change in immunosuppression. Belatacept a co-stimulation blocking agent is considered least nephrotoxic, and may provide an immunosuppression option in patients with TMA.

Methods

A retrospective review of prospectively collected data was conducted on kidney transplant from 2013 to 2019, 45 kidney transplant patients were switched from CNI’s to a Belatacept due to concerns of TMA. Seventy percent of the patients had kidney biopsy proven changes of TMA. Continuous variables are being reported as mean with SD. A paired t-test was used and P value of <0.05 was considered to be significant.

Results

Majority of patients were Hispanic with age 54Y± 11.9, 55% were females. Post belatacept switch follow up on these patients was 29.8±15 months. Significant improvement in pre and post switch serum creatinine (p=0.0001) and urine protein/creatinine (0.006) was observed (Graph). Fourteen patients had detectable DSA at the time of switch, out of these 4 patients were still positive at last follow up, where as 2 new patients developed DSAs. Four (8%) patients developed acute cellular rejection, and one (2%) patient had AMR.

Conclusion

Belatacept appears to be useful alternative immunosuppressive agent in kidney transplant patients with TMA without increasing the risk of rejection. Switching maintenance immunosuppression to Belatacept will likely result in significant improvement in renal outcome.