Open AccessConversion from tacrolimus to belatacept improves renal function in kidney transplant patients with chronic vascular lesions in allograft biopsy
Author(s) -
María José PérezSáez,
Bryant Yu,
Audrey Uffing,
Naoka Murakami,
Thiago J. Borges,
Jamil Azzi,
Sandra El Haji,
Steven Gabardi,
Leonardo V. Riella
Publication year - 2018
Publication title -
clinical kidney journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.033
H-Index - 40
eISSN - 2048-8513
pISSN - 2048-8505
DOI - 10.1093/ckj/sfy115
Subject(s) - medicine , tacrolimus , belatacept , urology , renal function , biopsy , cohort , kidney , retrospective cohort study , kidney transplantation , transplantation , kidney transplant , surgery
Background Conversion from tacrolimus to belatacept has been shown to be beneficial for an increasing number of kidney transplant (KT) patients. Predicting factors for favorable outcomes are still unknown. We aimed to investigate whether histological vascular lesions at the time of conversion might correlate with greater improvement in renal function post-conversion. Methods The study was conducted on a retrospective cohort of 34 KT patients converted from tacrolimus to belatacept. All patients underwent an allograft biopsy prior to conversion. We analyzed the evolution of the estimated glomerular filtration rate (eGFR) at 3 and 12 months after conversion. Results Median time to conversion was 6 (2–37.2) months post-transplant. About 52.9% of patients had moderate-to-severe chronic vascular lesions (cv2–3). We observed an increase in eGFR in the whole cohort from 35.4 to 41 mL/min/1.73 m2 at 3 months (P = 0.032) and 43.7 at 12 months (P = 0.013). Nine patients experienced acute rejection post-conversion, with one graft loss observed beyond the first year after conversion. Patients with cv2–3 had significant improvement in eGFR at 12 months (+8.6 mL/min/1.73 m2; 31.6 to 40.2 mL/min/1.73 m2; P = 0.047) compared with those without these lesions (+6.8 mL/min/1.73 m2; 40.9 to 47.7 mL/min/1.73 m2; P = 0.148). Conclusions Conversion from tacrolimus to belatacept has a beneficial effect in terms of renal function in KT patients. This benefit might be more significant in patients with cv in the biopsy.