Chen Jeanne M, Mangus Richard S, Sharfuddin Asif A, Powelson John A, Yaqub Muhammad S, Jan Muhammad Y, Lutz Andrew J, Fridell Jonathan A
IU Health, Department of Pharmacy, Indianapolis, USA.
IU Health/Indiana University School of Medicine, Department of Surgery, Indianapolis, USA.
Clin Transplant. 2025 Oct;39(10):e70310. doi: 10.1111/ctr.70310.
Belatacept may be used to spare or replace calcineurin inhibitors (CNI) to preserve renal function. Use in pancreas transplant (PTx) is limited by increased risk of pancreas rejection. This retrospective analysis included all PTxs performed between 2004 and 2023. A 1:2 case/control analysis was performed to identify predictors of belatacept use and compare allograft and patient survival. Of 731 PTxs, 21 (3%) started belatacept (eight simultaneous pancreas and kidney (SPK), three pancreas after kidney (PAK), and 10 pancreas transplant alone (PTA). At 1 year, Δ estimated glomerular filtration rate (eGFR) was +7% SPK, -15% PAK, and +32% PTA. Case-control analysis found no demographic predictors for belatacept except older recipient age for PTA. No difference in median kidney, pancreas, or patient survival was observed compared to control. Pancreas rejection occurred in two SPKs. There were two death censored pancreas allograft failures, both PTAs. Kidney allografts failed in two SPK and one PAK. Eight patients died. Six were still receiving belatacept at time of death with functioning allografts. Belatacept use after PTx is safe and can provide some renal recovery. Belatacept was initiated with eGFR approaching 20 mL/min/1.73m. Earlier introduction may result in better outcomes.
贝拉西普可用于替代或停用钙调神经磷酸酶抑制剂（CNI）以保护肾功能。在胰腺移植（PTx）中的应用因胰腺排斥风险增加而受到限制。这项回顾性分析纳入了2004年至2023年间进行的所有PTx。进行了1:2病例对照分析，以确定使用贝拉西普的预测因素，并比较移植物和患者的生存率。在731例PTx中，21例（3%）开始使用贝拉西普（8例同期胰肾联合移植（SPK），3例肾后胰腺移植（PAK），10例单纯胰腺移植（PTA））。1年时，估计肾小球滤过率（eGFR）的变化为：SPK组增加7%，PAK组降低15%，PTA组增加32%。病例对照分析发现，除PTA组受者年龄较大外，没有其他人口统计学因素可预测贝拉西普的使用。与对照组相比，肾、胰腺或患者的中位生存期无差异。2例SPK发生了胰腺排斥。有2例死亡截尾的胰腺移植物失败，均为PTA。2例SPK和1例PAK的肾移植失败。8例患者死亡。6例在死亡时仍在使用贝拉西普，移植物功能良好。PTx后使用贝拉西普是安全的，并且可以使肾功能得到一定恢复。贝拉西普在eGFR接近20 mL/min/1.73m²时开始使用。更早使用可能会带来更好的结果。
