Santeusanio Andrew D, Bhansali Arjun, Weinberg Alan, Shapiro Ron, Delaney Veronica, Florman Sander, De Boccardo Graciela
Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA.
Department of Pharmacy, Mount Sinai Hospital, New York, NY, USA.
Clin Transplant. 2020 Apr;34(4):e13823. doi: 10.1111/ctr.13823. Epub 2020 Mar 13.
Early conversion from a calcineurin inhibitor to belatacept has the potential to improve long-term renal allograft function; however, there remains limited experience with this strategy among African Americans and patients with preformed donor-specific antibodies (DSA). To examine these subgroups, we performed a single-center review of kidney transplant recipients converted to belatacept within 1-year of transplant between 01/2011 and 10/2017. All patients received lymphocyte-depleting induction with maintenance tacrolimus and mycophenolate +/- corticosteroids. Patients were switched to belatacept for clinical indication and followed from date of conversion until allograft failure or study conclusion. The primary endpoint at 1-year was a composite of allograft loss, biopsy proven rejection, de novo DSA formation, proteinuria, and declining renal function. Thirty-two patients were included in the review. The majority were African American, and 28.1% had DSA at transplant. Patient and allograft survival at 1-year was 96.9% and 93.8%, respectively, and estimated glomerular filtration rate improved from 41.9 to 58.4 mL/min. No African Americans or patients with pretreatment DSA developed rejection or allograft failure within 1-year. The only clinical variable correlated with suboptimal allograft function was baseline weight ≥80 kg (OR = 6.2; 95% CI, 1.2-32.3). Early conversion to belatacept appears safe for select patients with DSA and African Americans receiving lymphocyte-depleting induction.
早期从钙调神经磷酸酶抑制剂转换为贝拉西普有可能改善长期肾移植功能；然而，在非裔美国人和预先存在供体特异性抗体（DSA）的患者中，这种策略的经验仍然有限。为了研究这些亚组，我们对2011年1月至2017年10月期间在移植后1年内转换为贝拉西普的肾移植受者进行了单中心回顾性研究。所有患者均接受淋巴细胞清除诱导治疗，并维持使用他克莫司和霉酚酸酯+/-皮质类固醇。因临床指征将患者转换为贝拉西普，并从转换日期开始随访，直至移植肾失功或研究结束。1年时的主要终点是移植肾丢失、活检证实的排斥反应、新生DSA形成、蛋白尿和肾功能下降的综合指标。该回顾性研究纳入了32例患者。大多数为非裔美国人，28.1%的患者在移植时有DSA。1年时患者和移植肾存活率分别为96.9%和93.8%，估计肾小球滤过率从41.9提高到58.4 mL/min。1年内没有非裔美国人或预处理时有DSA的患者发生排斥反应或移植肾失功。与移植肾功能欠佳相关的唯一临床变量是基线体重≥80 kg（OR = 6.2；95%CI，1.2 - 32.3）。对于接受淋巴细胞清除诱导治疗的有DSA的特定患者和非裔美国人，早期转换为贝拉西普似乎是安全的。
