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Conversion to belatacept maintenance immunosuppression in HIV‐positive kidney transplant recipients
Author(s) -
Santeusanio Andrew,
Bhansali Arjun,
De Boccardo Graciela,
Sehgal Vinita,
Delaney Veronica,
Florman Sander,
Shapiro Ron
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14041
Subject(s) - belatacept , medicine , immunosuppression , kidney transplantation , retrospective cohort study , urology , kidney transplant , surgery , oncology , transplantation
Abstract There are only scattered case reports documenting belatacept use in HIV + kidney transplant recipients. We performed a retrospective review to describe short‐term outcomes following conversion to belatacept in a cohort of HIV + patients. Patients were included if they were converted to belatacept between May 2015 and May 2019, had an HIV‐ donor, and received ≥4 doses of belatacept. All patients were treated with non‐depleting induction and triple maintenance immunosuppression. Allograft and HIV‐related outcomes were collected from the date of belatacept infusion until May 2020. Ten HIV + kidney transplant recipients were identified, who were converted to belatacept a median of 364 days post‐transplant. At last follow‐up (median 3.3 years), 8 patients remained on belatacept therapy, and all patients were alive with functioning allografts. Mean estimated glomerular filtration rates (eGFR) improved from 31.6 mL/min at baseline to 42.8 mL/min at 1 year ( P = .03). Two patients developed acute rejection, with one necessitating conversion back to tacrolimus. All patients maintained undetectable HIV‐1 viral loads at last follow‐up. One patient each developed pneumocystis pneumonia and Kaposi sarcoma following conversion, which were responsive to standard medical therapy. In our cohort of stable HIV + kidney transplant recipients, conversion to belatacept was associated with excellent early patient and allograft survival and improved eGFR at 1 year.