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Belatacept rescue conversion in kidney transplant recipients with vascular lesions (Banff cv score >2):  a retrospective cohort study.
Bertrand, Dominique; Matignon, Marie; Morel, Antoine; Ludivine, Lebourg; Lemoine, Mathilde; Hanoy, Mélanie; Roy, Frank Le; Nezam, Dorian; Hamzaoui, Mouad; de Nattes, Tristan; Moktefi, Anissa; François, Arnaud; Laurent, Charlotte; Etienne, Isabelle; Guerrot, Dominique.
Afiliación
  • Bertrand D; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • Matignon M; Nephrology and Transplantation Department, Cancerology-Immunity-Transplantation-Infectiology, Clinical Investigation Center-Biotherapies, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, INSERM U955, Paris-Est-Créteil University, Paris, France.
  • Morel A; Nephrology and Transplantation Department, Cancerology-Immunity-Transplantation-Infectiology, Clinical Investigation Center-Biotherapies, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, INSERM U955, Paris-Est-Créteil University, Paris, France.
  • Ludivine L; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • Lemoine M; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • Hanoy M; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • Roy FL; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • Nezam D; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • Hamzaoui M; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • de Nattes T; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • Moktefi A; Department of Pathology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est-Créteil University, Paris, France.
  • François A; Department of Pathology, CHU Rouen, Rouen, France.
  • Laurent C; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • Etienne I; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
  • Guerrot D; Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
Nephrol Dial Transplant ; 38(2): 481-490, 2023 02 13.
Article en En | MEDLINE | ID: mdl-35544123
BACKGROUND: Immunosuppression in kidney transplant recipients with decreased graft function and histological vascular changes can be particularly challenging. The impact of a late rescue conversion to belatacept on kidney graft survival in this context has never been studied. METHODS: We report a bicentric retrospective cohort study comparing a calcineurin inhibitor (CNI) to belatacept switch versus CNI continuation in 139 kidney transplant recipients with histological kidney vascular damage (cv ≥2, g + cpt ≤1, i + t ≤1) and low estimated glomerular filtration rate (≤40 mL/min/1.73 m²). Primary outcome was death-censored graft survival. RESULTS: During the study follow-up, 10 graft losses (14.5%) occurred in the belatacept group (n = 69) versus 26 (37.1%) in the matched CNI group (n = 70) (P = .005). Death-censored graft survival was significantly higher in the belatacept group (P = .001). At 3 years, graft survival was 84.0% in the belatacept group compared with 65.1% in the control group. Continuing CNI was an independent risk factor for graft loss [hazard ratio (HR) 3.46; P < .005]. The incidence of cellular rejection after the conversion was low (4.3% in both groups) and not significantly different between groups (P = .84). Patients switched to belatacept developed significantly less donor-specific antibodies de novo. Belatacept was an independent risk factor for the occurrence of opportunistic infections (HR 4.84; P < .005). CONCLUSION: The replacement of CNI with belatacept in patients with decreased allograft function and vascular lesions is associated with an improvement in graft survival and represents a valuable option in a context of organ shortage. Caution should be exercised regarding the increased risk of opportunistic infection.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Riñón / Inmunosupresores Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Nephrol Dial Transplant Asunto de la revista: NEFROLOGIA / TRANSPLANTE Año: 2023 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Riñón / Inmunosupresores Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Nephrol Dial Transplant Asunto de la revista: NEFROLOGIA / TRANSPLANTE Año: 2023 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido