Overall Infectious Complications Related to Belatacept Conversion in Comparison to Tacrolimus in Kidney Transplant Recipients

Abstract

Introduction: Belatacept has demonstrated effectiveness for preventing rejection in kidney transplant and has a favorable side effect profile. Studies assessing long-term infectious complications with belatacept compared to tacrolimus are limited. Project Aims: The purpose of this program evaluation was to determine the proportion of patients who developed an infection when converted to belatacept compared to those on tacrolimus. Design: In this retrospective evaluation, kidney transplant recipients receiving belatacept were matched 1:1 to those receiving tacrolimus, based on transplant date, age, induction immunosuppression, and cytomegalovirus risk. Data collection was initiated in tacrolimus patients on the date of belatacept conversion in the belatacept-matched patients. Data were extracted until study conclusion, death, or discontinuation of belatacept. Patients were stratified into 3 groups based on time of conversion posttransplant, which included early, late, and very late conversion. The primary outcome was the proportion of patients with an infection in belatacept compared to tacrolimus. Outcome data were calculated using chi-square, Fisher's exact test, student's t-test or Mann-Whitney U test where appropriate. Results: A total of 328 matched patients were included in the analysis. More patients on belatacept developed an infection compared to tacrolimus (42.7% vs 29.9%, P = 0.02), which was primarily driven by pneumonia (6.1% vs 0.5%; P = 0.01). Higher incidences of infections were identified in those converted within 6 months from transplant. Conclusions: Belatacept was associated with a higher proportion of patients with infections compared to tacrolimus, particularly in those converted within 6 months from time of transplant.

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

“…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. 20,22 Last, in our study, we observed for the first time an improvement in allograft survival up to 7 years post-conversion after belatacept conversion compared with matched patients treated with CNIs while the projected allograft survival was similar before conversion at the time of matching using the qualified iBox system. 23 This result was consistent whether in the subgroup of patients with DGF, with DSA at the time of conversion, or transplanted from an expanded criteria donor.…”

“…[16][17][18][19] Therefore, belatacept conversion seems to be promising, despite the higher incidence of acute rejection and opportunistic infections. [19][20][21][22] However, these studies were based on small numbers of patients and have not investigated the long-term graft outcomes post-conversion. This may explain why the CNI avoidance strategy is not implemented in the majority of transplant centers worldwide in the case of CNI intolerance.…”

“…16–19 Therefore, belatacept conversion seems to be promising, despite the higher incidence of acute rejection and opportunistic infections. 19–22…”

Clinical outcomes of SARS‐CoV‐2 infection in kidney transplant recipients on belatacept: a single‐center experience

“…To the Editor, Belatacept, a maintenance immunosuppressive agent increasingly used among kidney transplant recipients (KTR), has been associated with an increased risk of infections. [1][2][3][4] However, clinical outcomes of SARS-CoV-2 infected KTR on belatacept are unknown. We analyzed KTR on belatacept who had SARS-CoV-2 infection between March 12, 2020 and October 31, 2022.…”

“…Fionna Feller 1,2 Marwan M. Azar 3 Jennifer Marvin 4 Elizabeth Cohen 4 Sarthak Virmani 5 Maricar Malinis 3 1…”