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Kidney Week

Abstract: TH-PO831

Renal Allograft Function Outcomes After Conversion from Conventional Immunosuppression to Belatacept Plus Low-Dose Conventional Drug Regimen

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Aslam, Ahsan, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Li, Yang, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Lane, Kathleen A., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Jan, Muhammad Yahya, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Adebiyi, Oluwafisayo O., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Sharfuddin, Asif A., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Yaqub, Muhammad S., Indiana University School of Medicine, Indianapolis, Indiana, United States

Group or Team Name

  • Division of Nephrology and Hypertension.
Background

Calcineurin Inhibitors (CNI) and Sirolimus have been traditionally used as immunosuppressants to prevent rejection in kidney transplant recipients but they are often associated with undesirable renal and metabolic adverse effects . Belatacept which is a selective T-cell costimulation blocker does not have the undesirable AE's.Data on using Belatacept and low dose CNI/Sirolimus combination is scant.At our institution,patients are switched to this regimen if they had Slow/delayed graft function,complications related to CNIs or graft rejection while on these drugs.

Methods

It is a retrospective chart review study. We included all patients >18 years of age at Indiana University Hospital who had a Kidney transplant and were switched from Tacrolimus, Sirolimus or Cyclosporine to a combination of Belatacept and lower dose CNI/Sirolimus .'Response' (to the addition of belatacept) was defined as >10% change in the eGFR per year from baseline (pre-belatacept values) over 2 years. Logistic regression models were performed.

Results

N=79
Mean Age=53 years.
History of deceased donor kidney transplant= 64 %.
Response was observed in 54% of patients with improved eGFR by 6 months (p= 0.003) and sustained by 2 years eGFR of 49.1+/-19.5 vs. 35.3 +/-11.4 (p = 0.04). The mean duration of dialysis in responders vs. non responders was 32 and 52 months, respectively (p= 0.057) and there was no difference in tacrolimus levels post conversion. By univariate anlayses, non-response was significantly associated with retransplant (OR= 4.93) and higher level of proteinuria (OR= 1.51),and history of graft rejection before belatacept (OR= 3.45).

Conclusion

Belatacept in combination with low dose conventional immunosuppression appears to be a favorable option in patients with slow/delayed graft function or intolerance to conventional drugs at their therapeutic levels.