Conversion From Calcineurin Inhibitors to Belatacept in HLA-sensitized Kidney Transplant Recipients With Low-level Donor-specific Antibodies
| Autor: | Renaud Snanoudj, Dany Anglicheau, Christophe Legendre, Marc-Olivier Timsit, Camilo E Ulloa, Anne Scemla, Frank Martinez, Rebecca Sberro-Soussan |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Graft Rejection Male Isoantigens Biopsy Calcineurin Inhibitors Human leukocyte antigen 030230 surgery Pharmacology Kidney Kidney transplant Belatacept Nephrotoxicity Abatacept 03 medical and health sciences 0302 clinical medicine HLA Antigens Isoantibodies Humans Medicine Renal Insufficiency Aged Transplantation biology medicine.diagnostic_test Drug Substitution business.industry Donor specific antibodies Middle Aged Allografts Kidney Transplantation body regions Calcineurin Treatment Outcome biology.protein Female 030211 gastroenterology & hepatology Antibody business Glomerular Filtration Rate medicine.drug |
| Zdroj: | Transplantation. 103:2150-2156 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000002592 |
| Popis: | Belatacept could be the treatment of choice in renal-transplant recipients with renal dysfunction attributed to calcineurin inhibitor (CNI) nephrotoxicity. Few studies have described its use in patients with donor-specific antibody (DSA).We retrospectively evaluated conversion from CNIs to belatacept in 29 human leukocyte antigen-immunized renal-transplant recipients. Data about acute rejection, DSA, and renal function were collected. These patients were compared with 42 nonimmunized patients treated with belatacept.Patients were converted from CNIs to belatacept a median of 444 days (interquartile range, 85-1200) after transplantation and were followed up after belatacept conversion, for a median of 308 days (interquartile range, 125-511). At conversion, 16 patients had DSA. Nineteen DSA were observed in these 16 patients, of which 11/19 were1000 mean fluorescence intensity (MFI), 7/19 were between 1000 and 3000 MFI, and one was3000 MFI. At last follow-up, preexisting DSA had decreased or stabilized. Seven patients still had DSA with a mean MFI of 1298 ± 930 at the last follow-up. No patient developed a de novo DSA in the DSA-positive group. In the nonimmunized group, one patient developed de novo DSA (A24-MFI 970; biopsy for cause did not show biopsy-proven acute rejection or microinflammation score). After belatacept conversion, one antibody-mediated rejection was diagnosed. The mean estimated glomerular filtration rate improved from 31.7 ± 14.2 mL/min/1.73 m to 40.7 ± 12.3 mL/min/1.73 m (P0.0001) at 12 months after conversion. We did not find any significant difference between groups in terms of renal function, proteinuria, or biopsy-proven acute rejection.We report on a safe conversion to belatacept in human leukocyte antigen-immunized patients with low DSA levels. |
| Databáze: | OpenAIRE |
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