Belatacept Conversion in Kidney Transplant Recipients with Congestive Heart Failure: Survival and 30-Day Readmission Outcomes

Abstract

Calcineurin inhibitors (CNIs) are deleterious to cardiovascular risk in kidney transplant recipients (KTRs). Data on the impact of belatacept on KTRs with congestive heart failure (CHF) are scarce. We hypothesized that conversion to belatacept will have better patient and graft survival and a lower rate of readmissions within 30 days after discharge compared with long-term CNI use. We analyzed data from KTRs admitted to CHF between 2014 and 2019. A total of 28 recipients converted to belatacept and were matched with 339 who continued on CNIs. There was no significant difference in patient demographics, or primary disease between the two groups. The adjusted hazard ratio associated with conversion was (0.87 [95% CI, 0.35-2.11] for death, (0.91, [95% CI, 0.39-2.13] for graft failure and (adjusted hazard ratio, 1.91, [95% confidence interval (CI), 0.90–4.06]) for 30-day postdischarge readmission between the two groups. Patients converted to belatacept were at a higher risk of rejection (adjusted hazard ratio, 13.8; 95% CI, 7.48–25.3). Patient and graft survival and 30-day readmission after CHF hospital discharge did not differ significantly between belatacept conversion and CNI continuation. The incidence of rejection was higher in the belatacept conversion group, suggesting a need for closer follow-up of patients on belatacept therapy.