Single-Center Outcomes of Conversion to Belatacept in Kidney Transplant Recipients

IF 1.9 4区 医学 Q2 SURGERY
Eve Carciofi, Spencer LeCorchick, Lance Lindberg, Rebecca Braun, Elise Heiman, Li Dong, Zubair Zafar, Sanjiv Anand
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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.

肾移植受者转用belataccepept的单中心结果
Belatacept (Bt)转化与肾移植患者(KTxP)排斥风险增加有关。该研究包括接受肾移植并转化为Bt的患者。给予诱导,随后使用钙调磷酸酶抑制剂(CNI)、抗代谢物和类固醇维持。基于患者风险,bt后CNI逐渐减少。患者被分为三个队列:转化前排斥反应(RP)、无排斥反应(NR)和转化后排斥反应(RA)。主要结果是在转换后1年活检证实的急性排斥反应(BPAR)。次要结果包括估计肾小球滤过率(eGFR)和12个月患者和移植物生存的变化。分析每个BPAR病例与dd-cfDNA、MMDx和epet匹配的一致性。在纳入研究的69名患者中,10.1%的患者在转换后出现BPAR。RP患者在转换后12个月的eGFR较低,中位数为23 mL/min (IQR 16-45),而NR和RA患者分别为44 mL/min(31-66)和39 mL/min(34-50)。在所有RA活检中,Dd-cfDNA在活检前升高。组织病理学结果与MMDx报告有75%的差异。Bt转化前的排斥反应与较低的eGFR相关,而Bt转化后的排斥反应维持与未发生排斥反应的eFGR相似。Bt转化应该被认为是安全有效的。
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来源期刊
Clinical Transplantation
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.
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