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Abstract: FR-PO820

Differences in Outcomes Between High Dose and Low Dose Belatacept Conversion on Allograft Function in Kidney Transplant Patients

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Me, Hay Me, Mayo Clinic Arizona, Scottsdale, Arizona, United States
  • Budhiraja, Pooja, Mayo Clinic Arizona, Scottsdale, Arizona, United States
  • Kodali, Lavanya, Mayo Clinic Arizona, Scottsdale, Arizona, United States
  • Sukumaran Nair, Sumi, Mayo Clinic Arizona, Scottsdale, Arizona, United States
Background

Belatacept, a selective costimulation T cell blocker is used to avoid unwanted side effects from calcineurin inhibitors. Improved allograft function despite increased risk of early rejection and viral infection have been reported.

Methods

This is a single center retrospective study conducted at Mayo Clinic Arizona. We converted patients to the high dose belatacept (10mg/kg) if transplanted within 1 month and to the low dose (5mg/kg) after 1 month if they had significant side effects with calcineurin inhibitors or suboptimal allograft function with chronicity changes on biopsy findings. Tacrolimus dose was discontinued immediately in high dose conversion group but was overlapped and tapered down within 4 weeks in low dose conversion group. We included both deceased donor and living donor transplant recipients from 2013 to 2021. We compared the effect of high dose and low dose on the occurrence of rejection and infection at 1 year.

Results

Total of 75 patients were switched to belatacept and 56 (74%) was converted to low dose and 17 (26%) were converted to high dose. No statistical difference found in recipient and donor characteristics between 2 groups (Fig 1). There was no statistical significance in allograft function, rejection rate and infection rate at 1 year (Fig 2). However, the ocurrence of COVID 19 infection was statistically significant in high dose conversion group.

Conclusion

Allograft function was comparable at 12 months between 2 groups for those transplaned within 1 year. It is important to recognize the potential for over-immunosuppression when transitioning to belatacept.