Belatacept in renal transplant recipient with mild immunologic risk factor: A pilot prospective study (BELACOR)

Autor: Laurent Salomon, Stéphanie Malard, Thomas Robert, Caroline Pilon, Emmanuelle Boutin, Florence Canoui-Poitrine, Antoine Durrbach, Marie Matignon, Anissa Zarour, Claire Leibler, Anissa Moktefi, Philippe Grimbert, Chloé Samson, Pierre-André Natella
Přispěvatelé: Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), service Anatomie et Cytologie Pathologique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Génomique Fonctionnelle, Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), IMRB - CEPIA/'Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health' [Créteil] (U955 Inserm - UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Groupe Henri Mondor-Albert Chenevier, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Hôpital Albert Chenevier, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Necker - Enfants Malades [AP-HP], Clinical Research Unit (URC Mondor), Hôpitaux Universitaires Henri-Mondor AP-HP, Néphrologie [CHU Bicêtre], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Service de néphrologie, dialyse, aphérèses et transplantation, CHU Grenoble-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Graft Rejection
Male
Pilot Projects
kidney transplantation/nephrology
immunosuppression/immune modulation
030230 surgery
Kidney Function Tests
law.invention
Postoperative Complications
0302 clinical medicine
Randomized controlled trial
Isoantibodies
Risk Factors
law
Immunology and Allergy
Medicine
Pharmacology (medical)
Prospective Studies
immunosuppressant - fusion proteins and monoclonal antibodies
Prospective cohort study
belatacept
Incidence (epidemiology)
Graft Survival
clinical trial
Middle Aged
Prognosis
Female
rejection
Immunosuppressive Agents
Glomerular Filtration Rate
medicine.drug
medicine.medical_specialty
Urology
Renal function
clinical research/practice
Belatacept
Abatacept
03 medical and health sciences
antibody-mediated (ABMR)
panel reactive antibody (PRA)
Humans
Risk factor
Retrospective Studies
Transplantation
business.industry
Kidney Transplantation
Calcineurin
Clinical trial
Kidney Failure
Chronic
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
business
Follow-Up Studies
Zdroj: American Journal of Transplantation
American Journal of Transplantation, 2019, 19 (3), pp.894-906. ⟨10.1111/ajt.15229⟩
ISSN: 1600-6135
1600-6143
Popis: The benefit of belatacept on antibody-mediated rejection (ABMR) incidence after kidney transplant with preformed donor-specific antibodies (DSAs) has never been assessed. Between 2014 and 2016, we conducted a multicenter prospective clinical trial with 49 patients to determine kidney allograft outcome in recipients with preformed DSAs (maximal mean fluorescence intensity 500 to 3000) treated with belatacept (BELACOR trial). Immunosuppressive strategy included antithymocyte globulin, belatacept, mycophenolate mofetil, and steroids. An ancillary control group was designed retrospectively, including patients fulfilling the same inclusion criteria treated with calcineurin inhibitors. In BELACOR group, no patient exhibited acute ABMR, patient and allograft survival at 1 year was 100% and 95.4%, respectively, and the estimated glomerular filtration rate was 53.2 mL/min/1.73 m2 . However, the 12-month incidence of acute T cell-mediated rejection was 25.4% (14.5% to 42.4%). Comparison with the control group showed significantly higher T cell-mediated rejection incidence only in the BELACOR group (P = .003). Considering the DSAs, the outcome was similar in the 2 groups except a significantly higher number of patients displayed a complete disappearance of class II DSAs in the BELACOR group (P = .001). Belatacept was not associated with an acute ABMR increased risk and may be considered as immunosuppressive strategy in transplant recipients with preformed DSAs (maximal mean fluorescence intensity 500 to 3000). Prospective randomized trials are needed to confirm these results.
Databáze: OpenAIRE
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