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Kidney Week

Abstract: TH-PO833

Expanded One-Year Experience of Bimonthly Belatacept

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Christensen, Johanna L., VCUHealth, Richmond, Virginia, United States
  • Thompson, Randi, VCUHealth, Richmond, Virginia, United States
  • Winstead, Ryan, VCUHealth, Richmond, Virginia, United States
  • Kamal, Layla, VCUHealth, Richmond, Virginia, United States
  • Gupta, Gaurav, VCUHealth, Richmond, Virginia, United States
Background

Belatacept (bela) is a common immunosuppressive (IS) drug in kidney transplant (KT). We have over 300 KT patients on bela. Our initial cohort of expanded 2 monthly belatacept had favorable results so we expanded our cohort from 18 to 34 patients, and continued monitoring until year post conversion.

Methods

34 patients at high risk of infection were included who were beyond one year from transplant and had no donor specific antibody (DSA) or prior episodes of rejection. They had stable allograft function and maintenance IS included bela 5mg/kg monthly, median mycophenolate mofetil dosing of 1g daily and prednisone 5mg daily. We monitored donor derived cell free DNA (ddcfDNA; Allosure), DSA, total IgG level, and CD4 counts at baseline and then at 2, 4, 6, and 12 months. Repeated measures ANOVA was used to assess statistical changes with multiple comparisons adjusted with Tukey-HSD.

Results

20/34 (59%) patients were African American. The mean time on bela at initiation was 48.1± 30.0 months. The estimated glomerular filtration rate (eGFR; Mean± SE) did not change significantly between initiation and month 12 (43.5 ± 3.3 vs 46.3± 6.6 ml/min). There was no significant change in ddcfDNA between months 0 (0.23± 0.03%), 2, 4 and 6 (0.20±0.06%) months, though at month 12 there was an uptrend in mean ddcfDNA in 10 patients that have achieved this interval (0.43± 0.06%). There was no difference in absolute CD4 count; mean± SE between month 0 and 12 (326 ± 33.9 vs 368.7 ± 72.5; p= 0.94) and similar results were noted for IgG levels (939.5.2± 57.2 vs 861.0 ± 124.2; p=0.72). 1 patient developed low grade DSA at 6 months, which resolved spontaneously. 1 patient underwent biopsy for proteinuria which showed advanced diabetic nephropathy. One patient underwent biopsy for acute rise in ddcfDNA with DSA, which showed antibody mediated rejection, which resolved after intensive therapy and return to monthly bela infusions. There were no graft losses.

Conclusion

This report evaluating q2m bela, in a carefully selected and monitored cohort, demonstrates low risk of rejection with change in dose interval. There was no significant change in DSA or ddcfDNA or incidence of major opportunistic infections. Long term outcome monitoring is needed, and close interval assessment of ddcfDNA and DSA is critical for management of these patients in order to reduce the risk of acute rejection.