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Belatacept‐based immunosuppression: A calcineurin inhibitor‐sparing regimen in heart transplant recipients
Author(s) -
Launay Ma,
Guitard Joelle,
Dorent Richard,
Prevot Yoann,
Prion Florent,
Beaumont Laurence,
Kably Benjamin,
Lecuyer Lucien,
Billaud Eliane M.,
Guillemain Romain
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15584
Subject(s) - medicine , belatacept , calcineurin , discontinuation , immunosuppression , regimen , renal function , transplantation , urology , surgery , kidney transplantation , retrospective cohort study , heart transplantation , kidney transplant
Belatacept ( BTC ) is indicated for prophylaxis of graft rejection in adults receiving a renal transplant (Tx). This retrospective observational study (three centers) included all heart transplant recipients receiving BTC between January 2014 and October 2018. Forty EBV + patients mean GFR 35 ± 20 mL /min/m 2 were identified, among whom belatacept was initiated during the first 3 months after transplantation in 12 patients, and later in 28 patients. Several patients were multiorgan transplant recipients. Study outcomes were GFR , safety, and changes in immunosuppressive therapy. The main reason for switching to BTC was to preserve renal function, resulting in discontinuation of CNI and changes in immunosuppressive therapy in 76% of cases. At study closeout, 24/40 patients were still on BTC therapy. GFR was improved (+59%, P = .0002*) within 1 month, particularly in the early group. More episodes of rejection were observed among “late” patients (1 death). Sixteen treatment discontinuations were recorded: GFR recovery (n = 4), DSA no longer detectable (n = 1), compliance issues (n = 3), poor venous access (n = 2), multiple infections (n = 1), 1 death (fungal lung infection), and treatment failure (n = 4). Median follow‐up was 24 months. Four patients developed de novo DSA ( MFI <1500). BTC is an effective alternative immunosuppressive for postoperative transient kidney failure, stabilizing delayed renal function, with acceptable safety profile under careful monitoring.