dc.contributor.author
Choi, Mira
dc.contributor.author
Bachmann, Friederike
dc.contributor.author
Wu, Kaiyin
dc.contributor.author
Lachmann, Nils
dc.contributor.author
Schmidt, Danilo
dc.contributor.author
Brakemeier, Susanne
dc.contributor.author
Duerr, Michael
dc.contributor.author
Kahl, Andreas
dc.contributor.author
Eckardt, Kai-Uwe
dc.contributor.author
Budde, Klemens
dc.contributor.author
Nickel, Peter
dc.date.accessioned
2022-05-03T10:52:05Z
dc.date.available
2022-05-03T10:52:05Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/34933
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-34651
dc.description.abstract
Background: In de novo kidney transplant recipients (KTR) treatment with belatacept has been established as a comparable option as maintenance immunosuppression, preferably as a strategy to convert from calcineurin inhibitor (CNI)- to belatacept-based immunosuppression. Switch to belatacept demonstrated improved renal function in patients with CNI-induced nephrotoxicity, but risk of transplant rejection and the development of donor-specific antibodies (DSA) are still a matter of debate. Only few data are available in patients at increased immunological risk and late after transplantation.
Methods: We analyzed 30 long-term KTR (including 2 combined pancreas-KTR) converted from CNI to belatacept > 60 months after transplantation with moderate to severe graft dysfunction (GFR ≤ 45 mL/min). Biopsies were classified according to the Banff 2015 criteria. Group differences were assessed in a univariate analysis using Mann Whitney U or Chi square test, respectively. Multivariate analysis of risk factors for treatment failure was performed using a binary logistic regression model including significant predictors from univariate analysis. Fifty-six KTR matched for donor and recipient characteristics were used as a control cohort remaining under CNI-treatment.
Results: Patient survival in belatacept cohort at 12/24 months was 96.7%/90%, overall graft survival was 76.7 and 60.0%, while graft survival censored for death was 79.3%/66.7%. In patients with functioning grafts, median GFR improved from 22.5 mL/min to 24.5 mL/min at 24 months. Positivity for DSA at conversion was 46.7%. From univariate analysis of risk factors for graft loss, GFR < 25 mL/min (p = 0.042) and Banff microvascular inflammation (MVI) sum score ≥ 2 (p = 0.023) at conversion were significant at 24 months. In the analysis of risk factors for treatment failure, a MVI sum score ≥ 2 was significant univariately (p = 0.023) and in a bivariate (p = 0.037) logistic regression at 12 months. DSA-positivity was neither associated with graft loss nor treatment failure. The control cohort had comparable graft survival outcomes at 24 months, albeit without increase of mean GFR in patients with functioning grafts (ΔGFR of - 3.6 ± 8.5 mL/min).
Conclusion: Rescue therapy with conversion to belatacept is feasible in patients with worsening renal function, even many years after transplantation. The benefit in patients with MVI and severe GFR impairment remains to be investigated.
en
dc.rights.uri
https://creativecommons.org/licenses/by/4.0/
dc.subject
Allograft failure
en
dc.subject
Kidney transplantation
en
dc.subject
Calcineurin inhibitor toxicity
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Microvascular inflammation is a risk factor in kidney transplant recipients with very late conversion from calcineurin inhibitor-based regimens to belatacept
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.articlenumber
354
dcterms.bibliographicCitation.doi
10.1186/s12882-020-01992-6
dcterms.bibliographicCitation.journaltitle
BMC Nephrology
dcterms.bibliographicCitation.originalpublishername
Springer Nature
dcterms.bibliographicCitation.volume
21
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.funding
Springer Nature DEAL
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
32819287
dcterms.isPartOf.eissn
1471-2369