Belatacept Conversion in Kidney After Liver Transplantation

• Authors: Octav Cristea, Emory University; Geeta Karadkhele, Emory Transplant Center; William H Kitchens, Emory University Hospital; Payaswini Vasanth, Emory University; Christian Larsen, Emory University; Idelberto Badell, Emory University
• Journal Title: Transplantation Direct
• Volume: Volume 7, Number 11
• Publisher: Wolters Kluwer Health, Inc. | 2021-10-22, Pages E780-E780
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1097/TXD.0000000000001229
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Kidney; Belatacept Conversion

Abstract

Background. Costimulatory blockade with belatacept has demonstrated long-term benefits in renal transplantation, but de novo use in liver transplant recipients has resulted in increased rejection, graft loss, and death. However, belatacept conversion as a calcineurin inhibitor (CNI) avoidance strategy has not been studied and may be of benefit in liver transplantation where CNI-induced renal dysfunction and toxicity are barriers to improved outcomes. Methods. Using clinical data extracted from our institutional medical record, we report on 8 patients who underwent kidney after liver transplantation and were treated with belatacept-based immunosuppression and transient CNI therapy. Results. All patients tolerated belatacept therapy without any patient deaths or graft losses. No episodes of rejection, de novo donor-specific antibody formation, or major systemic infections were observed, and all patients demonstrated preserved liver and excellent renal allograft function. Patients received belatacept for a median duration of 13.2 mo, and at a median follow-up of 15.9 mo post-kidney transplant, 6 of 8 patients continued on belatacept with 3 completely off and 3 poised to transition off CNI. Conclusions. These findings are the first evidence that in liver transplant recipients requiring subsequent kidney transplantation, belatacept-based therapy can potentially facilitate CNI-free maintenance immunosuppression. This supports the possibility of belatacept conversion in stand-alone liver transplant recipients as a viable method of CNI avoidance.