Long-Term Outcomes of Belatacept Versus Tacrolimus Following T-Cell Depleting Induction in Adult Kidney Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-04-15 DOI:10.1111/ctr.70154

Laura E. Newton, Thomas W. D'Angelo, Michael C. Chobanian, Michael F. Daily, Asha M. Zimmerman

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Abstract

Background

Belatacept shows promise as an alternative immunosuppressant without the nephrotoxicity of calcineurin inhibitors. Avoiding nephrotoxicity is important with the expanding use of organs at risk of marginal graft function. To date, no large studies have compared belatacept directly with tacrolimus after T-cell depleting induction in renal transplantation.

Methods

The Standard Transplant Analysis and Research file was used to compare adult kidney transplant recipients induced with T-cell depleting agents treated with belatacept to propensity score-matched recipients treated with tacrolimus between August 10, 2011 and June 29, 2023. Kaplan–Meier survival analysis was used to compare death censored graft survival, patient survival, and time to acute rejection.

Results

During the study period, 4391 adult kidney transplant recipients were treated with belatacept. Estimated GFR improved for belatacept-treated patients through year 9, whereas it decreased for the control group through year 10. Belatacept-treated patients had a higher rejection rate at 5 years (21% vs. 15%, p < 0.001). Death-censored graft survival did not differ between groups (p = 0.383). Among patients who had rejection, death-censored graft survival was superior in belatacept-treated patients at 5 years (70% vs. 60%, p = 0.026). Overall, patient survival did not differ between groups (p = 0.120).

Conclusions

This is the largest longitudinal study to compare outcomes of belatacept versus tacrolimus-based therapy following T-cell depleting induction. Belatacept was associated with improved graft function despite an increased acute rejection rate. There was no difference in overall graft or patient survival compared to tacrolimus. This study suggests that belatacept-based therapy is not inferior to tacrolimus-based therapy following T-cell depletion.

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成人肾移植中t细胞消耗诱导后贝拉他普与他克莫司的长期疗效

背景贝拉西普有望成为一种替代性免疫抑制剂，而不会产生降钙素抑制剂的肾毒性。随着移植器官功能减退风险的扩大，避免肾毒性非常重要。迄今为止，还没有大型研究对肾移植T细胞耗竭诱导后的贝拉替塞与他克莫司进行直接比较。方法使用标准移植分析和研究档案，比较 2011 年 8 月 10 日至 2023 年 6 月 29 日期间使用贝拉替塞诱导 T 细胞耗竭剂治疗的成人肾移植受者与使用他克莫司治疗的倾向得分匹配受者。采用卡普兰-梅耶生存分析法比较死亡删减后的移植物存活率、患者存活率和急性排斥反应发生时间。结果在研究期间，4391 名成年肾移植受者接受了贝拉替塞治疗。贝拉替赛治疗组患者的估计 GFR 在第 9 年有所改善，而对照组患者的估计 GFR 在第 10 年有所下降。贝拉他赛普治疗患者5年后的排斥率较高（21% vs. 15%，p < 0.001）。死亡剪除后的移植物存活率在各组之间没有差异（p = 0.383）。在出现排斥反应的患者中，贝拉替塞治疗的患者5年后的死亡校正移植物存活率更高（70% vs. 60%，p = 0.026）。总体而言，各组患者的存活率没有差异（p = 0.120）。结论这是一项规模最大的纵向研究，比较了贝拉替塞与他克莫司疗法在T细胞耗竭诱导后的疗效。尽管急性排斥反应发生率增加，但贝拉他赛普能改善移植物功能。与他克莫司相比，移植物或患者的总体存活率没有差异。这项研究表明，在T细胞耗竭后，贝拉替塞疗法并不比他克莫司疗法差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.