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BENEFIT  and  BENEFIT ‐ EXT  were phase  III  studies of cytotoxic T‐cell crossmatch–negative kidney transplant recipients randomized to belatacept more intense ( MI )‐based, belatacept less intense ( LI )‐based, or cyclosporine‐based immunosuppression. Following study completion, presence/absence of  HLA ‐specific antibodies was determined centrally via solid‐phase flow cytometry screening. Stored sera from anti‐ HLA –positive patients were further tested with a single‐antigen bead assay to determine antibody specificities, presence/absence of donor‐specific antibodies ( DSA s), and mean fluorescent intensity ( MFI ) of any  DSA s present. The effect of belatacept‐based and cyclosporine‐based immunosuppression on  MFI  was explored post hoc in patients with preexisting  DSA s enrolled to  BENEFIT  and  BENEFIT ‐ EXT . In  BENEFIT , preexisting  DSA s were detected in 4.6%, 4.9%, and 6.3% of belatacept  MI ‐treated, belatacept  LI ‐treated, and cyclosporine‐treated patients, respectively. The corresponding values in  BENEFIT ‐ EXT  were 6.0%, 5.7%, and 9.2%. In both studies, most preexisting  DSA s were of class I specificity. Over the first 24 months posttransplant, a greater proportion of preexisting  DSA s in belatacept‐treated versus cyclosporine‐treated patients exhibited decreases or no change in  MFI .  MFI  decline was more apparent with belatacept  MI ‐based versus belatacept  LI ‐based immunosuppression in both studies and more pronounced in  BENEFIT ‐ EXT  versus  BENEFIT . Although derived post hoc, these data suggest that belatacept‐based immunosuppression decreases preexisting  DSA s more effectively than cyclosporine‐based immunosuppression.

american journal of transplantation

Posttransplant reduction in preexisting donor‐specific antibody levels after belatacept‐ versus cyclosporine‐based immunosuppression: Post hoc analyses of  BENEFIT  and  BENEFIT ‐ EXT