Early Conversion to Belatacept: A Case-Control Study

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In kidney transplant recipients with low kidney function, early conversion from tacrolimus- to belatacept-based immunosuppression leads to a small but significant increase in estimated glomerular filtration rate (GFR), reports a study in Transplantation.

The retrospective study included two groups of 30 matched transplant recipients with low but stable eGFR: typically less than less than 40 mL/min/m2 (median 23 mL/min/m2. From 2012 to 2016, the study center had a protocol to convert patients with low kidney function at least 1 month posttransplant from tacrolimus to belatacept. Cases were matched on a wide range of variables to controls maintained on calcineurin inhibitors (CNIs).

Mean change in GFR during the first 4 months after conversion was 11 mL/min/m2 in patients converted to belatacept versus 4.8 mL/min/m2 in the control cohort. This was despite a 16.7% rate of acute rejection in the conversion group, compared to zero in the control group. The improvement in kidney function was still present after 1 year. The two groups had similar allograft and patient survival at 2 years.

Previous reports from the BENEFIT trial showed better kidney function in patients started on belatacept-based immunosuppression after kidney transplantation, compared to CNIs. Less is known about the effects of converting from CNI- to belatacept-based therapy.

This retrospective study reports a “modest increase” in kidney function with early conversion from tacrolimus to belatacept in kidney recipients with low but stable eGFR [Elhamahmi DA, et al. Early conversion to belatacept in kidney transplant recipient with low glomerular filtration rate [Transplantation 2017; DOI: 10.1097/TP.0000000000001985].