Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
Transpl Int. 2023 Jul 24;36:11328. doi: 10.3389/ti.2023.11328. eCollection 2023.
The first COVID-19 stay-at-home order came into effect in France on 17 March 2020. Immunocompromised patients were asked to isolate themselves, and outpatient clinic visits were dramatically reduced. In order to avoid visits to the hospital by belatacept-treated kidney transplant recipients (KTRs) during the initial period of the pandemic, we promptly converted 176 KTRs at two French transplant centers from once-monthly 5 mg/kg in-hospital belatacept infusion to once-weekly 125 mg subcutaneous abatacept injection. At the end of follow-up (3 months), 171 (97.16%) KTRs survived with a functioning graft, 2 (1.14%) had died, and 3 (1.70%) had experienced graft loss. Two patients (1.1%) experienced acute T cell-mediated rejection. Nineteen patients (10.80%) discontinued abatacept; 47% of the KTRs found the use of abatacept less restrictive than belatacept, and 38% would have preferred to continue abatacept. Mean eGFR remained stable compared to baseline. Seven patients (3.9%) had COVID-19; among these, two developed severe symptoms but survived. Only one patient had a DSA. Side effects of abatacept injection were uncommon and non-severe. Our study reports for the first time in a large cohort that once-weekly injection of abatacept appears to be feasible and safe in KTRs previously treated with belatacept.
2020 年 3 月 17 日，法国首次发布了 COVID-19 居家令。免疫功能低下的患者被要求进行自我隔离，门诊就诊量大幅减少。为避免在疫情初期接受贝利尤单抗治疗的肾移植受者（KTR）前往医院，我们迅速将法国两家移植中心的 176 例 KTR 从每月一次的 5mg/kg 贝利尤单抗院内输注转换为每周一次的 125mg 皮下阿巴西普注射。在随访结束时（3 个月），171 例（97.16%）KTR 存活且移植物功能正常，2 例（1.14%）死亡，3 例（1.70%）发生移植物丢失。2 例（1.1%）患者发生急性 T 细胞介导的排斥反应。19 例（10.80%）患者停用阿巴西普；47%的 KTR 认为使用阿巴西普比贝利尤单抗限制更少，38%的患者更愿意继续使用阿巴西普。与基线相比，平均 eGFR 保持稳定。7 例（3.9%）患者感染 COVID-19；其中，2 例发展为严重症状但幸存。仅有 1 例患者出现了 DSA。阿巴西普注射的副作用不常见且不严重。本研究首次在大型队列中报告，每周一次的阿巴西普注射在先前接受贝利尤单抗治疗的 KTR 中似乎是可行且安全的。
