Eve Carciofi, Spencer LeCorchick, Lance Lindberg, Rebecca Braun, Elise Heiman, Li Dong, Zubair Zafar, Sanjiv Anand
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引用次数: 0
Abstract
Belatacept (Bt) conversion is associated with increased rejection risk in kidney transplant patients (KTxP). The study included patients who underwent kidney transplant and were converted to Bt. Induction was given, followed by maintenance with a calcineurin inhibitor (CNI), antimetabolite, and steroid. CNI was tapered post-Bt based on patient risk. Patients were divided into three cohorts: rejection prior to conversion (RP), no rejection (NR), and rejection after conversion (RA). The primary outcome was biopsy-proven acute rejection (BPAR) at 1 year post conversion. Secondary outcomes included change in estimated glomerular filtration rate (eGFR) and 12-month patient and graft survival. Concordance with dd-cfDNA, MMDx, and eplet matching was analyzed for each BPAR incidence.
Out of 69 patients included in the study, 10.1% had BPAR post conversion. RP patients’ eGFR was lower at 12 months post conversion, median 23 mL/min (IQR 16–45) compared to NR and RA patients, 44 mL/min (31–66) and 39 mL/min (34–50) respectively. Dd-cfDNA was elevated prior to biopsy in all RA biopsies. Histopathologic findings differed from MMDx reports 75% of the time. Rejection prior to Bt conversion is associated with lower eGFR, whereas rejection after Bt conversion maintains an eFGR similar to those without rejection. Bt conversion should be considered safe and effective.
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.