Department of Internal Medicine, Kaiser Fontana Medical Center, Fontana, California.
Department of Nephrology, Kaiser Los Angeles Medical Center, Los Angeles, California.
Transplant Proc. 2021 Apr;53(3):976-983. doi: 10.1016/j.transproceed.2020.11.001. Epub 2021 Jan 19.
Conversion from calcineurin inhibitor (CNI)-based to belatacept-based immunosuppression has become common; however, numerous protocols have emerged in lieu of a standardized protocol. The purpose of this study was to characterize belatacept conversion protocols from multiple centers and observe outcomes.
This was a retrospective study that included Kaiser Permanente Southern California members. The primary outcome was rejection 6 months after conversion and secondary outcomes included change in serum creatinine and graft loss.
Seventy-eight patients were included. Thirteen distinct protocols were identified from 8 different transplant centers. Protocols varied by initial dose, induction schedule, and CNI taper. The observed rate of rejection was 6%. There was a trend toward an association of rejection with lower tacrolimus exposure at the time of conversion and lower mycophenolic acid dosing postconversion. Graft survival was 88% and patient survival was 94%. There was a significant improvement in creatinine after conversion. Those with early conversions and creatinine >2.0 mg/dL at the time of conversion had the best response.
A large variety of belatacept conversion protocols were identified. Protocols were defined by the initial dose, induction regimen, and CNI taper. Rejection rates were low and may be influenced by exposure to maintenance immunosuppression during and after conversion. Most patients showed stabilization and improvement in creatinine postconversion, with the largest effect in those with an early conversion and serum creatinine >2.0 mg/dL.
钙调磷酸酶抑制剂（CNI）-为基础的向贝利尤单抗为基础的免疫抑制的转换已变得常见；然而，出现了许多方案而不是标准化方案。本研究的目的是描述多个中心的贝利尤单抗转换方案并观察结果。
这是一项回顾性研究，包括 Kaiser Permanente Southern California 的成员。主要结局是转换后 6 个月的排斥反应，次要结局包括血清肌酐的变化和移植物丢失。
共纳入 78 例患者。从 8 个不同的移植中心确定了 13 个不同的方案。方案在初始剂量、诱导方案和 CNI 减量方面存在差异。观察到的排斥反应发生率为 6%。转换时他克莫司暴露量较低和转换后霉酚酸剂量较低与排斥反应呈趋势相关。移植物存活率为 88%，患者存活率为 94%。转换后肌酐有显著改善。早期转换和转换时肌酐>2.0mg/dL 的患者反应最好。
确定了大量不同的贝利尤单抗转换方案。方案由初始剂量、诱导方案和 CNI 减量来定义。排斥反应发生率低，可能与转换期间和转换后维持免疫抑制的暴露有关。大多数患者在转换后肌酐稳定和改善，在早期转换和血清肌酐>2.0mg/dL 的患者中效果最大。
