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For: Dürr M, Lachmann N, Zukunft B, Schmidt D, Budde K, Brakemeier S. Late Conversion to Belatacept After Kidney Transplantation: Outcome and Prognostic Factors. Transplant Proc 2017;49:1747-1756.e1. [DOI: 10.1016/j.transproceed.2017.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/13/2017] [Indexed: 12/31/2022]

For:	Dürr M, Lachmann N, Zukunft B, Schmidt D, Budde K, Brakemeier S. Late Conversion to Belatacept After Kidney Transplantation: Outcome and Prognostic Factors. Transplant Proc 2017;49:1747-1756.e1. [DOI: 10.1016/j.transproceed.2017.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/13/2017] [Indexed: 12/31/2022]

Number

Cited by Other Article(s)

Tönshoff B, Patry C, Fichtner A, Höcker B, Böhmig GA. New Immunosuppressants in Pediatric Kidney Transplantation: What's in the Pipeline for Kids? Pediatr Transplant 2025;29:e70008. [PMID: 39711054 DOI: 10.1111/petr.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 11/05/2024] [Accepted: 12/08/2024] [Indexed: 12/24/2024]

Divard G, Aubert O, Debiais-Deschamp C, Raynaud M, Goutaudier V, Sablik M, Sayeg C, Legendre C, Obert J, Anglicheau D, Lefaucheur C, Loupy A. Long-Term Outcomes after Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2024;19:628-637. [PMID: 38265815 PMCID: PMC11108246 DOI: 10.2215/cjn.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/19/2024] [Indexed: 01/25/2024]

Abstract

BACKGROUND

Conversion to a belatacept-based immunosuppression is currently used as a calcineurin inhibitor (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 after 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 CNIs, using optimal matching. The primary end point was death-censored allograft survival at 7 years. The secondary end points 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 donor-specific antibody, 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 CNIs (CNI control group). All recipient, transplant, functional, histologic, and immunologic parameters were well balanced between the two groups with a standardized mean difference below 0.05. At 7 years post-conversion to belatacept, allograft survival was 78% compared with 63% in the CNI control group ( P < 0.001 for log-rank test). The safety outcomes showed a similar rate of patient death (28% in the belatacept group versus 36% in the CNI control group), active antibody-mediated rejection (6% versus 7%), T-cell-mediated rejection (4% versus 4%), major adverse cardiovascular events, and cancer occurrence (9% versus 11%). A significantly higher rate of de novo proteinuria was observed in the belatacept group as compared with the CNI control group (37% versus 21%, P < 0.001).

CONCLUSIONS

This real-world evidence 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 CNIs.

CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER

Long-term Outcomes after Conversion to Belatacept, NCT04733131 .

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Affiliation(s)

Gillian Divard INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
Olivier Aubert INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Charlotte Debiais-Deschamp INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Marc Raynaud INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France
Valentin Goutaudier INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France
Marta Sablik INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France
Caroline Sayeg Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
Christophe Legendre INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Julie Obert INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France
Dany Anglicheau Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France Necker-Enfants Malades Institute, INSERM U1151, Université de Paris Cité, Paris, France
Carmen Lefaucheur INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
Alexandre Loupy INSERM U970 PARCC, Pa`ris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Paris, France Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

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Kitchens WH, Larsen CP, Badell IR. Costimulatory Blockade and Solid Organ Transplantation: The Past, Present, and Future. Kidney Int Rep 2023;8:2529-2545. [PMID: 38106575 PMCID: PMC10719580 DOI: 10.1016/j.ekir.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/01/2023] [Accepted: 08/28/2023] [Indexed: 12/19/2023] Open

Leal R, Pardinhas C, Martinho A, Sá HO, Figueiredo A, Alves R. Challenges in the Management of the Patient with a Failing Kidney Graft: A Narrative Review. J Clin Med 2022;11:6108. [PMID: 36294429 PMCID: PMC9605319 DOI: 10.3390/jcm11206108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open

Osmanodja B, Ronicke S, Budde K, Jens A, Hammett C, Koch N, Seelow E, Waiser J, Zukunft B, Bachmann F, Choi M, Weber U, Eberspächer B, Hofmann J, Grunow F, Mikhailov M, Liefeldt L, Eckardt KU, Halleck F, Schrezenmeier E. Serological Response to Three, Four and Five Doses of SARS-CoV-2 Vaccine in Kidney Transplant Recipients. J Clin Med 2022;11:jcm11092565. [PMID: 35566691 PMCID: PMC9105533 DOI: 10.3390/jcm11092565] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open

Affiliation(s)

Bilgin Osmanodja Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.) Correspondence: ; Tel.: +49-30-450-614-368
Simon Ronicke Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Klemens Budde Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Annika Jens Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Charlotte Hammett Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Nadine Koch Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Evelyn Seelow Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Johannes Waiser Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Bianca Zukunft Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Friederike Bachmann Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Mira Choi Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Ulrike Weber Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Bettina Eberspächer Labor Berlin—Charité Vivantes GmbH, 13353 Berlin, Germany; (B.E.); (J.H.)
Jörg Hofmann Labor Berlin—Charité Vivantes GmbH, 13353 Berlin, Germany; (B.E.); (J.H.)
Fritz Grunow Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Michael Mikhailov Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Lutz Liefeldt Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Kai-Uwe Eckardt Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Fabian Halleck Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.)
Eva Schrezenmeier Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.R.); (K.B.); (A.J.); (C.H.); (N.K.); (E.S.); (J.W.); (B.Z.); (F.B.); (M.C.); (U.W.); (F.G.); (M.M.); (L.L.); (K.-U.E.); (F.H.); (E.S.) Berlin Institute of Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany

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Serological Response to Three, Four and Five Doses of SARS-CoV-2 Vaccine in Kidney Transplant Recipients. J Clin Med 2022. [DOI: 10.3390/jcm11092565 expr 939359460 + 834636087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open

Morel A, Hoisnard L, Dudreuilh C, Moktefi A, Kheav D, Pimentel A, Sakhi H, Mokrani D, Attias P, El Sakhawi K, Champy CM, Remy P, Sbidian E, Grimbert P, Matignon M. Three-Year Outcomes in Kidney Transplant Recipients Switched From Calcineurin Inhibitor-Based Regimens to Belatacept as a Rescue Therapy. Transpl Int 2022;35:10228. [PMID: 35497889 PMCID: PMC9043102 DOI: 10.3389/ti.2022.10228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/18/2022] [Indexed: 01/05/2023]

Affiliation(s)

Antoine Morel Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
Léa Hoisnard AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Centre d'Investigation Clinique and Fédération Hospitalo-Universitaire TRUE (InnovaTive theRapy for immUne disordErs), Créteil, France.,Université Paris Est Créteil (UPEC), EpiDermE (Epidemiology in Dermatology and Evaluation of therapeutics), Créteil, France
Caroline Dudreuilh Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
Anissa Moktefi Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Pathology Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil, Créteil, France
David Kheav AP-HP (Assistance Publique-Hôpitaux de Paris), Laboratoire Régional d'histocompatibilité, Hôpital Saint Louis, Vellefaux, Paris
Ana Pimentel Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
Hamza Sakhi Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
David Mokrani Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
Philippe Attias Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
Karim El Sakhawi Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
Cécile Maud Champy Groupe Hospitalier Henri-Mondor/Albert Chenevier, Urology department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France
Philippe Remy Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil, Créteil, France
Emilie Sbidian AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Centre d'Investigation Clinique and Fédération Hospitalo-Universitaire TRUE (InnovaTive theRapy for immUne disordErs), Créteil, France.,Université Paris Est Créteil (UPEC), EpiDermE (Epidemiology in Dermatology and Evaluation of therapeutics), Créteil, France.,Department of Dermatology, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
Philippe Grimbert Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Centre d'Investigation Clinique and Fédération Hospitalo-Universitaire TRUE (InnovaTive theRapy for immUne disordErs), Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, CIC biotherapy, Créteil, France
Marie Matignon Nephrology and Renal Transplantation Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil, Créteil, France

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Influence of Belatacept- vs. CNI-Based Immunosuppression on Vascular Stiffness and Body Composition. J Clin Med 2022;11:jcm11051219. [PMID: 35268310 PMCID: PMC8911184 DOI: 10.3390/jcm11051219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/12/2022] [Accepted: 02/19/2022] [Indexed: 12/04/2022] Open

Belatacept Conversion Protocols and Outcomes in Kidney Transplant Recipients. Transplant Proc 2021;53:976-983. [PMID: 33478745 DOI: 10.1016/j.transproceed.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/15/2020] [Indexed: 11/22/2022]

Prevention of acute rejection after rescue with Belatacept by association of low-dose Tacrolimus maintenance in medically complex kidney transplant recipients with early or late graft dysfunction. PLoS One 2020;15:e0240335. [PMID: 33057374 PMCID: PMC7561183 DOI: 10.1371/journal.pone.0240335] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/24/2020] [Indexed: 01/23/2023] Open

Choi M, Bachmann F, Wu K, Lachmann N, Schmidt D, Brakemeier S, Duerr M, Kahl A, Eckardt KU, Budde K, Nickel P. Microvascular inflammation is a risk factor in kidney transplant recipients with very late conversion from calcineurin inhibitor-based regimens to belatacept. BMC Nephrol 2020;21:354. [PMID: 32819287 PMCID: PMC7439694 DOI: 10.1186/s12882-020-01992-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/29/2020] [Indexed: 01/05/2023] Open

Abstract

Background

In de novo kidney transplant recipients (KTR) treatment with belatacept has been established as a comparable option as maintenance immunosuppression, preferably as a strategy to convert from calcineurin inhibitor (CNI)- to belatacept-based immunosuppression. Switch to belatacept demonstrated improved renal function in patients with CNI-induced nephrotoxicity, but risk of transplant rejection and the development of donor-specific antibodies (DSA) are still a matter of debate. Only few data are available in patients at increased immunological risk and late after transplantation.

Methods

We analyzed 30 long-term KTR (including 2 combined pancreas-KTR) converted from CNI to belatacept > 60 months after transplantation with moderate to severe graft dysfunction (GFR ≤ 45 mL/min). Biopsies were classified according to the Banff 2015 criteria. Group differences were assessed in a univariate analysis using Mann Whitney U or Chi square test, respectively. Multivariate analysis of risk factors for treatment failure was performed using a binary logistic regression model including significant predictors from univariate analysis. Fifty-six KTR matched for donor and recipient characteristics were used as a control cohort remaining under CNI-treatment.

Results

Patient survival in belatacept cohort at 12/24 months was 96.7%/90%, overall graft survival was 76.7 and 60.0%, while graft survival censored for death was 79.3%/66.7%. In patients with functioning grafts, median GFR improved from 22.5 mL/min to 24.5 mL/min at 24 months. Positivity for DSA at conversion was 46.7%. From univariate analysis of risk factors for graft loss, GFR < 25 mL/min (p = 0.042) and Banff microvascular inflammation (MVI) sum score ≥ 2 (p = 0.023) at conversion were significant at 24 months. In the analysis of risk factors for treatment failure, a MVI sum score ≥ 2 was significant univariately (p = 0.023) and in a bivariate (p = 0.037) logistic regression at 12 months. DSA-positivity was neither associated with graft loss nor treatment failure. The control cohort had comparable graft survival outcomes at 24 months, albeit without increase of mean GFR in patients with functioning grafts (ΔGFR of − 3.6 ± 8.5 mL/min).

Conclusion

Rescue therapy with conversion to belatacept is feasible in patients with worsening renal function, even many years after transplantation. The benefit in patients with MVI and severe GFR impairment remains to be investigated.

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Costimulation Blockade in Kidney Transplant Recipients. Drugs 2020;80:33-46. [PMID: 31749062 PMCID: PMC6978297 DOI: 10.1007/s40265-019-01226-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]

Jorgenson MR, Descourouez JL, Brady BL, Bowman L, Hammad S, Kaiser TE, Laub MR, Melaragno JI, Park JM, Chandran MM. Alternatives to immediate release tacrolimus in solid organ transplant recipients: When the gold standard is in short supply. Clin Transplant 2020;34:e13903. [DOI: 10.1111/ctr.13903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 12/28/2022]

Noble J, Jouve T, Janbon B, Rostaing L, Malvezzi P. Belatacept in kidney transplantation and its limitations. Expert Rev Clin Immunol 2019;15:359-367. [DOI: 10.1080/1744666x.2019.1574570] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

Pérez-Sáez MJ, Yu B, Uffing A, Murakami N, Borges TJ, Azzi J, El Haji S, Gabardi S, Riella LV. Conversion from tacrolimus to belatacept improves renal function in kidney transplant patients with chronic vascular lesions in allograft biopsy. Clin Kidney J 2018;12:586-591. [PMID: 31384452 PMCID: PMC6671390 DOI: 10.1093/ckj/sfy115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 01/05/2023] Open

Zwart TC, Gokoel SRM, van der Boog PJM, de Fijter JW, Kweekel DM, Swen JJ, Guchelaar HJ, Moes DJAR. Therapeutic drug monitoring of tacrolimus and mycophenolic acid in outpatient renal transplant recipients using a volumetric dried blood spot sampling device. Br J Clin Pharmacol 2018;84:2889-2902. [PMID: 30176064 DOI: 10.1111/bcp.13755] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 02/06/2023] Open

Abstract

AIMS

Tacrolimus and mycophenolic acid dosing after renal transplantation is individualized through therapeutic drug monitoring (TDM). Home-based dried blood spot (DBS) sampling has the potential to replace conventional TDM sampling at the clinic. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay was developed to quantify tacrolimus and mycophenolic acid in DBS and clinically validated for abbreviated area under the concentration-time curve (AUC) monitoring using an innovative volumetric DBS sampling device.

METHODS

Clinical validation was performed by direct comparison of paired DBS and whole blood (WB) (tacrolimus) and plasma (mycophenolic acid) concentrations and AUCs. Agreement was evaluated using Passing-Bablok regression, Bland-Altman analysis and DBS-to-WB predictive performance. TDM dosing recommendations based on both methods were compared to assess clinical impact.

RESULTS

Paired tacrolimus (n = 200) and mycophenolic acid (n = 192) DBS and WB samples were collected from 65 kidney(-pancreas) transplant recipients. Differences for tacrolimus and mycophenolic acid were within ±20% for 84.5% and 76.6% of concentrations and 90.5% and 90.7% of AUCs, respectively. Tacrolimus and mycophenolic acid dosing recommendation differences occurred on 44.4% and 4.7% of occasions. Tacrolimus DBS dosing recommendations were 0.35 ± 0.14 mg higher than for WB and 8 ± 3% of the initial dose. Mycophenolic acid DBS dosing recommendations were 23.3 ± 31.9 mg lower than for plasma and 2 ± 3.5% of the initial dose.

CONCLUSIONS

Tacrolimus and mycophenolic acid TDM for outpatient renal transplant recipients, based on abbreviated AUC collected with a DBS sampling device, is comparable to conventional TDM based on WB sampling. Patient training and guidance on good blood-spotting practices is essential to ensure method feasibility.

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