Belatacept Improves Long-Term Renal Function after EDC Kidney Transplant

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Compared to cyclosporine, belatacept-based immunosuppression improves long-term outcomes in extended criteria donor (ECD) kidney recipients, reports a study in the American Journal of Transplantation.

The researchers present 7-year follow-up data on 543 kidney recipients from the “Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial–Extended Criteria Donors” (BENEFIT-EXT) study. Patients were assigned to primary immunosuppression with a more-intensive or less-intensive belatacept regimen, or to a cyclosporine regimen. Patient and graft survival and estimated glomerular filtration rate (eGFR) were assessed at 7 years’ follow-up.

With both the more- and less-intensive belatacept regimens, time to death or graft loss was similar to that with cyclosporine. At 7 years, mean estimated eGFR was 53.9 mL/min/1.73 m2 with more-intensive belatacept and 54.2 with less-intensive belatacept, compared to 35.3 with cyclosporine. Patients receiving less-intensive belatacept were less likely to meet a composite endpoint of death, graft loss, or eGFR of 20 mL/min/1.73 m2 or less: hazard ratio 0.706.

Acute rejection rates and safety outcomes were similar across regimens. The belatacept groups had lower rates of de novo donor-specific antibodies.

Belatacept might have advantages for ECD transplant recipients, who may be more vulnerable to nephrotoxicity from calcineurin inhibitors. As in the 5-year results, ECD kidney recipients receiving belatacept show improvement in eGFR through 7 years’ follow-up. Risks of death and graft loss are similar with belatacept versus cyclosporine, as are safety outcomes [Durrbach A, et al. Long-term outcomes in belatacept- versus cyclosporine-treated recipients of extended criteria donor kidneys: final results from BENEFIT-EXT, a phase III randomized study. Am J Transpl 2016; 16:3192–3201].