Conversion to belatacept-based immunosuppression therapy in renal transplant patients

Belatacept, a fusion protein that prevents stimulation of the CD28 receptor, does not have the adverse renal, cardiovascular, and metabolic adverse effects associated with calcineurin inhibitors (CNIs). We present data on 8 renal transplant patients with graft dysfunction who were switched from CNI-based immunosuppressive therapy to belatacept in response to patients' specific needs. In patients 1 through 5, the belatacept regimen comprised 5-mg/kg doses on days 1, 15, 28, 43, and 57, then every 28 days with a decrease in the CNI dose. The CNI dose was tapered: 100% on day 1, 60% on day 15, 30% on day 23, and discontinued on day 29. In patients 6, 7, and 8, belatacept was administered at 10 mg/kg on days 1, 5, 15, 28, 60, and 90, and then at 5 mg/kg every 28 days. CNIs were withdrawn completely on day 1. Reasons for switching were intolerance to CNI, CNI toxicity, vascular lesions, interstitial fibrosis/tubular atrophy, or arterial hypertension. Renal function improved in all cases. Belatacept is approved to be used de novo; the uniqueness of our cases is that it was used in conversion and in patients with renal dysfunction. In the short term, patients did not present with any serious adverse events related to belatacept or cellular or humoral acute rejection episodes.