Eid Rita, Scemla Anne, Giral Magali, Arzouk Nadia, Bertrand Dominique, Peraldi Marie-Noëlle, Mesnard Laurent, Longuet Helene, Maanaoui Mehdi, Desbuissons Geoffroy, Lefevre Edouard, Snanoudj Renaud
Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France.
Department of Nephrology and Transplantation, Necker University Hospital for Sick Children, AP-HP, Paris, France.
Transplant Direct. 2024 Apr 11;10(5):e1615. doi: 10.1097/TXD.0000000000001615. eCollection 2024 May.
Efficacy and safety of belatacept have not been specifically reported for kidney transplantations from donors after circulatory death.
In this retrospective multicenter paired kidney study, we compared the outcome of kidney transplantations with a belatacept-based to a calcineurin inhibitor (CNI)-based immunosuppression. We included all kidney transplant recipients from donors after uncontrolled or controlled circulatory death performed in our center between February 2015 and October 2020 and treated with belatacept (n = 31). The control group included the recipients of the contralateral kidney that were treated with CNI in 8 other centers (tacrolimus n = 29, cyclosporine n = 2).
There was no difference in the rate of delayed graft function. A higher incidence of biopsy-proven rejections was noted in the belatacept group (24 versus 6 episodes). Estimated glomerular filtration rate (eGFR) was significantly higher in the belatacept group at 3-, 12-, and 36-mo posttransplant, but the slope of eGFR was similar in the 2 groups. During a mean follow-up of 4.1 y, 12 patients discontinued belatacept and 2 patients were switched from CNI to belatacept. For patients who remained on belatacept, eGFR mean value and slope were significantly higher during the whole follow-up. At 5 y, eGFR was 80.7 ± 18.5 with belatacept versus 56.3 ± 22.0 mL/min/1.73 m with CNI ( = 0.003). No significant difference in graft and patient survival was observed.
The use of belatacept for kidney transplants from either uncontrolled or controlled donors after circulatory death resulted in a better medium-term renal function for patients remaining on belatacept despite similar rates of delayed graft function and higher rates of cellular rejection.
对于来自心脏死亡后供体的肾移植，贝拉西普的疗效和安全性尚未有专门报道。
在这项回顾性多中心配对肾研究中，我们比较了以贝拉西普为基础的免疫抑制与以钙调神经磷酸酶抑制剂（CNI）为基础的免疫抑制在肾移植中的结果。我们纳入了2015年2月至2020年10月在我们中心进行的、接受贝拉西普治疗的所有来自未控制或控制循环死亡后供体的肾移植受者（n = 31）。对照组包括在其他8个中心接受CNI治疗的对侧肾受者（他克莫司n = 29，环孢素n = 2）。
移植肾功能延迟恢复率无差异。贝拉西普组活检证实的排斥反应发生率更高（24次对6次）。移植后3个月、12个月和36个月时，贝拉西普组的估计肾小球滤过率（eGFR）显著更高，但两组eGFR的斜率相似。在平均4.1年的随访期间，12例患者停用了贝拉西普，2例患者从CNI转换为贝拉西普。对于继续使用贝拉西普的患者，在整个随访期间，eGFR平均值和斜率显著更高。在5年时，使用贝拉西普时eGFR为80.7±18.5，而使用CNI时为56.3±22.0 mL/min/1.73 m²（P = 0.003）。移植肾和患者生存率无显著差异。
对于来自未控制或控制循环死亡后供体的肾移植，使用贝拉西普可使继续使用贝拉西普的患者获得更好的中期肾功能，尽管移植肾功能延迟恢复率相似且细胞排斥率更高。
