Bertrand Dominique, Chavarot Nathalie, Olagne Jérôme, Greze Clarisse, Gatault Philippe, Danthu Clément, Colosio Charlotte, Jaureguy Maïté, Duveau Agnès, Bouvier Nicolas, Le Meur Yannick, Golbin Léonard, Thervet Eric, Thierry Antoine, François Arnaud, Laurent Charlotte, Lemoine Mathilde, Anglicheau Dany, Guerrot Dominique
Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Transpl Int. 2024 Dec 6;37:13544. doi: 10.3389/ti.2024.13544. eCollection 2024.
After kidney transplantation, conversion to belatacept is a promising alternative in patients with poor graft function or intolerance to calcineurin inhibitors. The risk of acute rejection has not been well described under these conditions. Here we present a retrospective multicenter study investigating the occurrence of acute rejection after conversion in 901 patients (2011-2021). The incidence of cellular and humoral rejection was 5.2% and 0.9%, respectively. T-cell mediated rejection (TCMR) occurred after a median of 2.6 months after conversion. Out of 47 patients with TCMR, death-censored graft survival was 70.1%, 55.1% and 50.8% at 1 year, 3 years and 5 years post-rejection, respectively. Eight patients died after rejection, mainly from infectious diseases. We compared these 47 patients with a cohort of kidney transplant recipients who were converted to belatacept between 2011 and 2017 and did not develop rejection (n = 238). In multivariate analysis, shorter time between KT and conversion, and the absence of anti-thymocyte globulin induction after KT were associated with the occurrence of TCMR after belatacept conversion. The occurrence of rejection after conversion to belatacept appeared to be less frequent than with use. Nevertheless, the risk of graft loss could be significant in patients with already low renal function.
肾移植后，对于移植肾功能不佳或对钙调神经磷酸酶抑制剂不耐受的患者，转换为贝拉西普是一种有前景的替代方案。在这些情况下，急性排斥反应的风险尚未得到充分描述。在此，我们开展了一项回顾性多中心研究，调查了901例患者（2011 - 2021年）转换治疗后急性排斥反应的发生情况。细胞性和体液性排斥反应的发生率分别为5.2%和0.9%。T细胞介导的排斥反应（TCMR）在转换治疗后中位2.6个月出现。在47例发生TCMR的患者中, 排除死亡因素后的移植肾存活率在排斥反应后1年、3年和5年分别为70.1%、55.1%和50.8%。8例患者在排斥反应后死亡，主要死于感染性疾病。我们将这47例患者与一组在2011年至2017年间转换为贝拉西普且未发生排斥反应的肾移植受者（n = 238）进行了比较。在多变量分析中，肾移植与转换治疗之间的时间较短以及肾移植后未使用抗胸腺细胞球蛋白诱导治疗与贝拉西普转换治疗后TCMR的发生相关。转换为贝拉西普后排斥反应的发生似乎比使用[原文此处可能有误，未明确提及使用何种药物]时更少见。然而，对于肾功能已经较低的患者，移植肾丢失的风险可能很大。
