Tailored use of belatacept in adolescent kidney transplantation
| Autor: | Annette M. Jackson, Del Wigfall, John W. Foreman, Rasheed Gbadegesin, Allan D. Kirk, Eileen Tsai Chambers, Shashi K. Nagaraj, Annabelle N. Chua, Rebecca E Sadun, Kathryn H. Blew |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Graft Rejection Nephrology medicine.medical_specialty Adolescent medicine.medical_treatment Calcineurin Inhibitors Urology 030230 surgery Belatacept Abatacept 03 medical and health sciences 0302 clinical medicine Maintenance therapy Internal medicine medicine Humans Immunology and Allergy Pharmacology (medical) Child Kidney transplantation Transplantation business.industry Graft Survival Immunosuppression medicine.disease Kidney Transplantation Calcineurin Sirolimus Alemtuzumab business Immunosuppressive Agents medicine.drug |
| Zdroj: | American Journal of Transplantation. 20:884-888 |
| ISSN: | 1600-6135 |
| Popis: | Adolescent transplant recipients are at risk for nonadherence, development of de novo donor-specific antibody (dnDSA), and allograft loss. Belatacept, a selective T cell costimulatory blocker, is associated with reduced dnDSA, improved renal function, and prolonged allograft survival when compared to calcineurin inhibitor-based regimens in adults; however, its use in children is scant. Three adolescents were initiated on belatacept between August 2017 and September 2018 at the time of kidney transplantation. Selection criteria included age ≥ 14 and EBV IgG + serostatus. Intraoperative alemtuzumab and methylprednisolone were given as induction therapy. Tailored maintenance therapy included steroid-free belatacept and sirolimus for two patients. One patient was initially maintained steroid-free on belatacept and belimumab, an inhibitor of B cell activating factor to treat concurrent systemic lupus erythematous; steroids were added subsequently. Renal function, biopsy-proven rejection, dnDSA, allograft survival, infection, nonadherence, and proteinuria were monitored. Renal function was 86, 73, 52 mL/min/1.73 m2 at 20, 20, and 8 months, respectively. There was 100% adherence to therapy and no development of dnDSA. All patients had treatable infections. One developed steroid-responsive acute cellular rejection. Belatacept-based regimens can be tailored for adolescent recipients with good short-term clinical outcomes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text