Acute Rejection After Kidney Transplant—An Endpoint Not Predictive of Treatment Effect on Graft Survival

Fitzsimmons, William E.; Naesens, Maarten

doi:10.1097/tp.0000000000004696

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…14,15,19 Conversely, previous studies showed that the incidence of acute rejection was higher in patients converted to belatacept without affecting allograft outcomes. 14,15 However, in the current era, this outcome is known to be not predictive of a treatment effect on long-term graft survival 29 and ignores changes in the Banff classification over the past 15 years. 30 In addition, our study reported reassuring safety outcomes with a similar proportion of death, major adverse cardiovascular outcomes consistent with the literature, 31 and no excess risk of infection conversely with previous observational studies.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes after Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant Recipients

Divard,

Aubert,

Debiais-Deschamp

et al. 2024

CJASN

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Background: Conversion to a belatacept-based immunosuppression is currently used as a calcineurin inhibitors (CNI) avoidance strategy when the CNI-based standard of care immunosuppression is not tolerated after kidney transplantation. However, there is a lack of evidence on the long-term benefit and safety following conversion to belatacept. Methods: We prospectively enrolled 311 kidney transplant recipients from 2007 to 2020 from two referral centers, converted from CNI to belatacept after transplant according to a prespecified protocol. Patients were matched at the time of conversion to patients maintained with CNI, using a optimal matching. The primary endpoint was the death-censored allograft survival at 7 years. The secondary endpoints were patient survival, eGFR and safety outcomes including serious viral infections, immune related complications antibody mediated-rejection, T-cell mediated rejection, de novo anti-HLA DSA, de novo diabetes, cardiovascular events and oncologic complications. Results: A total of 243 patients converted to belatacept (belatacept group) were matched to 243 patients maintained on CNI (CNI control group). All recipient, transplant, functional, histological and immunological parameters were well balanced between the two groups with a standardized mean difference below 0.05. At seven years post conversion to belatacept, allograft survival was 78% compared to 63% in the CNI control group (p<0.001 for log-rank test). The safety outcomes showed similar rate of patient death (28% in the belatacept group vs 36% in the CNI control group), active antibody mediated rejection (6% vs 7%), T-cell mediated rejection (4% vs 4%), major adverse cardiovascular events, and cancer occurrence (9% vs 11%). A significant higher rate of de novo proteinuria was observed in the belatacept group as compared to the CNI control group (37% vs 21%, p<0.001). Conclusions: This study shows that conversion to belatacept post-transplant was associated with lower risk of graft failure and acceptable safety outcomes compared with patients maintained on CNI.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes after Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant Recipients

Divard,

Aubert,

Debiais-Deschamp

et al. 2024

CJASN

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“…As extensively discussed at the 2022 Banff meeting, the diagnosis of TCMR, and in particular of borderline TCMR and chronic-active TCMR, remains challenging and will be the subject of ongoing study [26]. Accuracy in diagnosing the various phenotypes of TCMR is critical for the design of future clinical trials validating targeted and effective treatment protocols for these different TCMR phenotypes and, with that, further improvement of allograft outcomes [27].…”

Section: Key Pointsmentioning

confidence: 99%

Emerging phenotypes in kidney transplant rejection

Mengel,

Adam

2023

Current Opinion in Organ Transplantation

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Purpose of review This review focuses on more recently emerging rejection phenotypes in the context of time post transplantation and the resulting differential diagnostic challenges. It also discusses how novel ancillary diagnostic tools can potentially increase the accuracy of biopsy-based rejection diagnosis. Recent findings With advances in reducing immunological risk at transplantation and improved immunosuppression treatment renal allograft survival improved. However, allograft rejection remains a major challenge and represent a frequent course for allograft failure. With prolonged allograft survival, novel phenotypes of rejection are emerging, which can show complex overlap and transition between cellular and antibody-mediated rejection mechanisms as well as mixtures of acute/active and chronic diseases. With the emerging complexity in rejection phenotypes, it is crucial to achieve diagnostic accuracy in the individual patient. Summary The prospective validation and adoption of novel molecular and computational diagnostic tools into well defined and appropriate clinical context of uses will improve our ability to accurately diagnose, stage, and grade allograft rejection.

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Comparing the prognostic performance of iBOX and biopsy-proven acute rejection for long-term kidney graft survival

Klein,

Kosinski,

Loupy

et al. 2024

American Journal of Transplantation

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Acute Rejection After Kidney Transplant—An Endpoint Not Predictive of Treatment Effect on Graft Survival

Cited by 3 publications

References 23 publications

Long-Term Outcomes after Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant Recipients

Long-Term Outcomes after Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant Recipients

Emerging phenotypes in kidney transplant rejection

Comparing the prognostic performance of iBOX and biopsy-proven acute rejection for long-term kidney graft survival

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