Use of a Belatacept-based Immunosuppression for Kidney Transplantation From Donors After Circulatory Death: A Paired Kidney Analysis.

Autor: Eid R; Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France., Scemla A; Department of Nephrology and Transplantation, Necker University Hospital for Sick Children, AP-HP, Paris, France., Giral M; Department of Nephrology and Transplantation, Nantes University Hospital Centre, Nantes, France., Arzouk N; Department of Nephrology and Transplantation, Pitié Salpêtrière University Hospital, AP-HP, Paris, France., Bertrand D; Department of Nephrology and Transplantation, Rouen University Hospital Centre, Rouen, France., Peraldi MN; Department of Nephrology and Transplantation, Saint-Louis Hospital, AP-HP, Paris, France., Mesnard L; Department of Nephrology and Transplantation, Tenon Hospital, AP-HP, Paris, France., Longuet H; Department of Nephrology and Transplantation, Tours University Hospital Centre, Tours, France., Maanaoui M; Department of Nephrology and Transplantation, Lille University Hospital Centre, Lille, France., Desbuissons G; Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France., Lefevre E; Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France., Snanoudj R; Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France.
Jazyk: angličtina
Zdroj: Transplantation direct [Transplant Direct] 2024 Apr 11; Vol. 10 (5), pp. e1615. Date of Electronic Publication: 2024 Apr 11 (Print Publication: 2024).
DOI: 10.1097/TXD.0000000000001615
Abstrakt: Background: Efficacy and safety of belatacept have not been specifically reported for kidney transplantations from donors after circulatory death.
Methods: In this retrospective multicenter paired kidney study, we compared the outcome of kidney transplantations with a belatacept-based to a calcineurin inhibitor (CNI)-based immunosuppression. We included all kidney transplant recipients from donors after uncontrolled or controlled circulatory death performed in our center between February 2015 and October 2020 and treated with belatacept (n = 31). The control group included the recipients of the contralateral kidney that were treated with CNI in 8 other centers (tacrolimus n = 29, cyclosporine n = 2).
Results: There was no difference in the rate of delayed graft function. A higher incidence of biopsy-proven rejections was noted in the belatacept group (24 versus 6 episodes). Estimated glomerular filtration rate (eGFR) was significantly higher in the belatacept group at 3-, 12-, and 36-mo posttransplant, but the slope of eGFR was similar in the 2 groups. During a mean follow-up of 4.1 y, 12 patients discontinued belatacept and 2 patients were switched from CNI to belatacept. For patients who remained on belatacept, eGFR mean value and slope were significantly higher during the whole follow-up. At 5 y, eGFR was 80.7 ± 18.5 with belatacept versus 56.3 ± 22.0 mL/min/1.73 m 2 with CNI ( P  = 0.003). No significant difference in graft and patient survival was observed.
Conclusions: The use of belatacept for kidney transplants from either uncontrolled or controlled donors after circulatory death resulted in a better medium-term renal function for patients remaining on belatacept despite similar rates of delayed graft function and higher rates of cellular rejection.
(Copyright © 2024 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)
Databáze: MEDLINE
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