Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients

Gouin, Anna; Sberro-Soussan, Rébecca; Courivaud, Cécile; Bertrand, Dominique; Bello, Arnaud Del; Darres, Amandine; Ducloux, Didier; Legendre, Christophe; Kamar, Nassim

doi:10.1016/j.ekir.2020.09.036

Cited by 5 publications

(7 citation statements)

References 16 publications

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“…Only one study has reported a multicentric series of 44 patients converted from belatacept to another immunosuppressive drugs [ 27 ]. Results showed a significant decrease in eGFR from 44 to 36 mL/min/1.73 m 2 and the authors concluded that belatacept should not be stopped.…”

Section: Discussionmentioning

confidence: 99%

Time-Limited Therapy with Belatacept in Kidney Transplant Recipients

Letellier

Kervella²,

Sadek³

et al. 2022

JCM

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Introduction: In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit–risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results are analyzed in that study. Methods: We considered all the kidney transplant recipients that had been switched from conventional immunosuppressive therapy to belatacept and then for whom belatacept has been withdrawn intentionally. Furthermore, in the first 8 patients, we assessed changes in peripheral blood mononuclear cells (PBMC) transcriptome using RNAseq before and 3 months after belatacept withdrawal. Results: Over the study period, 28 out of 94 patients had belatacept intentionally withdrawn including 25 (89%) switched to low-dose CNI. One rejection due to poor compliance occurred. The eGFR after 12 months remained stable from 48 ± 19 mL.1.73 m−2 to 46 ± 17 mL.1.73 m−2 (p = 0.68). However, patients that resumed belatacept/withdrew CNIs (n = 10) had a trend towards a better eGFR comparing with the others (n = 15): 54 ± 20 mL.1.73 m−2 vs. eGFR 43 ± 16 mL.1.73 m−2, respectively (p = 0.15). The only factor associated with belatacept resumption was when the withdrawal took place during the COVID-19 outbreak. Transcriptome analysis of PBMCs, did not support rebound in alloimmune response. Conclusions: These findings underpin the use of belatacept as part of a time-limited therapy, in selected kidney transplant recipients, possibly as an approach to allow efficient vaccination against SARS-CoV-2.

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Section: Discussionmentioning

confidence: 99%

Time-Limited Therapy with Belatacept in Kidney Transplant Recipients

Letellier

Kervella²,

Sadek³

et al. 2022

JCM

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show abstract

“…Up to now, whether CNI avoidance should be indefinitely continued once kidney function improved had never been addressed. Only one study has reported a multicentric series of 44 patients converted from belatacept to another immunosuppressive drugs 26 . Results showed a significant decrease in eGFR from 44 to 36 ml/min/1.73m2 and the authors concluded that belatacept should not be stopped.…”

Section: Discussionmentioning

confidence: 99%

Time-Limited Therapy With Belatacept in Kidney Transplant Recipients

Letellier¹,

Kervella²,

Sadek³

et al. 2022

Preprint

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In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit-risk ratio, we established a strategy consisting of time-limited belatacept therapy / transient calcineurin inhibitor withdrawal, whose results are analyzed in that study. We considered all the kidney transplant recipients that had been switched from conventional immunosuppressive therapy to belatacept and then for whom belatacept has been withdrawn intentionally. Furthermore, in the first 8 patients, we assessed changes in peripheral blood mononuclear cells (PBMC) transcriptome using RNAseq before and 3 months after belatacept withdrawal. Over the study period, 28 out of 94 patients had belatacept intentionally withdrawn including 25 (89%) switched to low-dose CNI. One rejection due to poor compliance occurred. The eGFR after 12 months remained stable from 48 ± 19 ml.1.73m-2 to 46 ±17 ml.1.73m-2 (p = 0.68). However, patients that resumed belatacept / withdrew CNIs (n=10) had a trend towards a better eGFR comparing with the others (n =15): 54 ± 20 ml.1.73m-2 vs eGFR 43 ± 16 ml.1.73m-2 respectively (p = 0.15). The only factor associated with belatacept resumption was when the withdrawal took place during the COVID-19 outbreak. Transcriptome analysis of PBMCs, did not support rebound in alloimmune response. These findings underpin the use of belatacept as part of a time-limited therapy, in selected kidney transplant recipients, possibly as an approach to allow efficient vaccination against SARS-Cov-2.

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“…drug injections. While some centers converted patients back to oral immunosuppressive protocols [ 2 ] others initiated a specific infection control protocol [ 3 ]. In the current issue of Transplantation International two French transplant centers [ 4 ] describe an alternative approach and converted 176 patients from maintenance 5 mg i.v.…”

mentioning

confidence: 99%