About this item:

230 Views | 293 Downloads

Author Notes:

Corresponding Author: Christian P. Larsen, clarsen@emory.edu.

The authors wish to thank Cameron Evans, Bennett Evans, Hunter Roarke and Jahan Saedi for their assistance with the manuscript as well as Ulf Meier-Kriesche for his critical reading of the manuscript.

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation.

ABA and REP have received research support from Bristol-Myers Squibb.

ABA and TCP have received consulting fees from Bristol-Myers Squibb.

The other authors have no conflicts of interest to disclose.

Subject:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery
  • Transplantation
  • ORGAN-TRANSPLANT RECIPIENTS
  • DIFFERENTIATED THYROID-CANCER
  • CHRONIC KIDNEY-DISEASE
  • POOLED ANALYSIS
  • UNITED-STATES
  • RISK-FACTORS
  • ASSOCIATION
  • MORTALITY
  • STAGE
  • METAANALYSIS

Belatacept Combined With Transient Calcineurin Inhibitor Therapy Prevents Rejection and Promotes Improved Long-Term Renal Allograft Function

Show all authors Show less authors

Tools:

Journal Title:

American Journal of Transplantation

Volume:

Volume 17, Number 11

Publisher:

, Pages 2922-2936

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Belatacept, a T cell costimulation blocker, demonstrated superior renal function, lower cardiovascular risk, and improved graft and patient survival in renal transplant recipients. Despite the potential benefits, adoption of belatacept has been limited in part due to concerns regarding higher rates and grades of acute rejection in clinical trials. Since July 2011, we have utilized belatacept-based immunosuppression regimens in clinical practice. In this retrospective analysis of 745 patients undergoing renal transplantation at our center, we compared patients treated with belatacept (n = 535) with a historical cohort receiving a tacrolimus-based protocol (n = 205). Patient and graft survival were equivalent for all groups. An increased rate of acute rejection was observed in an initial cohort treated with a protocol similar to the low-intensity regimen from the BENEFIT trial versus the historical tacrolimus group (50.5% vs. 20.5%). The addition of a transient course of tacrolimus reduced rejection rates to acceptable levels (16%). Treatment with belatacept was associated with superior estimated GFR (belatacept 63.8 mL/min vs. tacrolimus 46.2 mL/min at 4 years, p < 0.0001). There were no differences in serious infections including rates of cytomegalovirus or BK viremia. We describe the development of a costimulatory blockade-based strategy that ultimately allows renal transplant recipients to achieve calcineurin inhibitor–free immunosuppression.

Copyright information:

© 2017 The American Society of Transplantation and the American Society of Transplant Surgeons

Export to EndNote