Carciofi Eve, LeCorchick Spencer, Lindberg Lance, Braun Rebecca, Heiman Elise, Dong Li, Zafar Zubair, Anand Sanjiv
Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA.
Enterprise Analytics, Intermountain Medical Center, Murray, Utah, USA.
Clin Transplant. 2025 Jul;39(7):e70220. doi: 10.1111/ctr.70220.
Belatacept (Bt) conversion is associated with increased rejection risk in kidney transplant patients (KTxP). The study included patients who underwent kidney transplant and were converted to Bt. Induction was given, followed by maintenance with a calcineurin inhibitor (CNI), antimetabolite, and steroid. CNI was tapered post-Bt based on patient risk. Patients were divided into three cohorts: rejection prior to conversion (RP), no rejection (NR), and rejection after conversion (RA). The primary outcome was biopsy-proven acute rejection (BPAR) at 1 year post conversion. Secondary outcomes included change in estimated glomerular filtration rate (eGFR) and 12-month patient and graft survival. Concordance with dd-cfDNA, MMDx, and eplet matching was analyzed for each BPAR incidence. Out of 69 patients included in the study, 10.1% had BPAR post conversion. RP patients' eGFR was lower at 12 months post conversion, median 23 mL/min (IQR 16-45) compared to NR and RA patients, 44 mL/min (31-66) and 39 mL/min (34-50) respectively. Dd-cfDNA was elevated prior to biopsy in all RA biopsies. Histopathologic findings differed from MMDx reports 75% of the time. Rejection prior to Bt conversion is associated with lower eGFR, whereas rejection after Bt conversion maintains an eFGR similar to those without rejection. Bt conversion should be considered safe and effective.
在肾移植患者（KTxP）中，贝拉西普（Bt）转换与排斥反应风险增加相关。该研究纳入了接受肾移植并转换为Bt的患者。给予诱导治疗，随后用钙调神经磷酸酶抑制剂（CNI）、抗代谢药物和类固醇进行维持治疗。基于患者风险，在Bt转换后逐渐减少CNI的用量。患者被分为三个队列：转换前排斥（RP）、无排斥（NR）和转换后排斥（RA）。主要结局是转换后1年经活检证实的急性排斥反应（BPAR）。次要结局包括估计肾小球滤过率（eGFR）的变化以及12个月时患者和移植物的存活率。分析了每种BPAR发生率与dd-cfDNA、MMDx和表位匹配的一致性。在该研究纳入的69例患者中，10.1%在转换后发生了BPAR。与NR和RA患者相比，RP患者在转换后12个月时的eGFR较低，中位数为23 mL/min（四分位间距16 - 45），而NR和RA患者分别为44 mL/min（31 - 66）和39 mL/min（34 - 50）。在所有RA活检中，活检前dd-cfDNA均升高。组织病理学结果与MMDx报告有75%的时间不同。Bt转换前的排斥反应与较低的eGFR相关，而Bt转换后的排斥反应维持的eFGR与无排斥反应的患者相似。应认为Bt转换是安全有效的。
