Abstract: PO2170
Reversal of Prolonged Delayed Graft Function Following Kidney Transplantation with a Belatacept-Based Regimen
Session Information
- Transplantation: Clinical - Underrecognized Risk Factors, Traditional Considerations, and Outcomes
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Routray, Sujit Kumar, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Chopra, Bhavna, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Nashar, Khaled, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
- Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
Group or Team Name
- AHN Nephrology
Introduction
Delayed graft function (DGF) following kidney transplantation is associated with adverse graft and patient outcomes. Many factors contribute to the development of DGF including ischemia-reperfusion injury. There is concern that calcineurin inhibitors such as tacrolimus can perpetuate DGF through tubular injury and vasoconstriction. The non-nephrotoxic co-stimulation blocker belatacept could potentially be beneficial in improving allograft function in such scenario. We present a patient who experienced prolonged DGF following kidney transplantation that reversed following switching immunosuppression from a tacrolimus-based to belatacept-based regimen.
Case Description
A 73-year old non-sensitized female with a history of coronary artery disease, hypertension, and type 2 diabetes mellitus on maintenance hemodialysis underwent kidney transplantation from a 63-year old brain-dead donor with acceptable procurement kidney biopsy and kidney donor profile index (KDPI) of 88%. Cold ischemia time was 27.5 hours. She received induction with Thymoglobulin followed by tacrolimus/mycophenolic acid maintenance with early steroid withdrawal. In the peri-operative period, she experienced hemodynamic instability from cardiogenic shock requiring prolonged ICU stay. She developed DGF requiring dialysis support. Despite clinical improvement, she remained dialysis-dependent. Allograft biopsies at 2 weeks and 2.5 months post-transplant showed acute tubular injury and no rejection. Four months from transplant, immunosuppression was changed from tacrolimus-based to belatacept-based regimen. One week after this change, the urine output started improving and 10 days later the patient came off dialysis. Her serum creatinine continues to improve with a most recent value of 2.4 mg/dl and excellent urine output 3 weeks since stopping dialysis.
Discussion
The patient experienced very prolonged DGF after receiving a high KDPI kidney. We believe that replacing tacrolimus with belatacept facilitated the reversal of prolonged DGF and freedom from dialysis in this patient. Conversion of tacrolimus to belatacept in kidney transplant recipients experiencing prolonged DGF and utilization of de novo belatacept-based maintenance regimen in patients at high risk for developing DGF should be considered in order to improve graft and possibly patient outcomes.