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Related Experiment Video

Updated: Apr 12, 2026

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
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Safe Conversion From Tacrolimus to Belatacept in High Immunologic Risk Kidney Transplant Recipients With Allograft

G Gupta1, A Regmi1, D Kumar1

  • 1Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|May 20, 2015
PubMed
Summary

Belatacept offers improved kidney function in sensitized kidney transplant recipients previously on tacrolimus. This switch, even with chronic fibrosis, showed no increased rejection or donor-specific antibodies, suggesting a safe alternative.

Keywords:
Calcineurin inhibitor (CNI)fusion proteins and monoclonal antibodies: belatacept, drug toxicity, immunosuppressantimmunosuppressantinterstitial fibrosis and tubular atrophysensitization

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Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • Limited data exists on belatacept use in sensitized kidney transplant recipients or regrafts.
  • Calcineurin inhibitor (CNI) toxicity and interstitial fibrosis/tubular atrophy are common challenges in high-risk kidney transplant recipients.
  • Tacrolimus is a standard immunosuppressant, but CNI toxicity can necessitate alternative treatments.

Purpose of the Study:

  • To evaluate the efficacy and safety of switching from tacrolimus to belatacept in kidney transplant recipients with high immunologic risk.
  • To assess changes in renal function, rejection rates, and donor-specific antibody (DSA) development after conversion.
  • To explore belatacept's potential benefits in patients with presumed CNI toxicity or chronic allograft damage.

Main Methods:

  • A retrospective analysis of six high-risk kidney transplant recipients converted from tacrolimus to belatacept.
  • Patients were switched due to presumed CNI toxicity and/or interstitial fibrosis/tubular atrophy.
  • Renal function (eGFR), rejection episodes, and DSA development were monitored post-conversion.

Main Results:

  • Significant improvement in mean estimated glomerular filtration rate (eGFR) from 23.8 to 42 mL/min/1.73 m(2) (p = 0.03) at 16.5 months follow-up.
  • No new rejection episodes occurred, despite a history of rejection in 33% of patients.
  • Surveillance biopsies and DSA monitoring showed no evidence of subclinical rejection or antibody development.

Conclusions:

  • Switching from tacrolimus to belatacept improved kidney function in sensitized, high-risk kidney transplant recipients.
  • This conversion was associated with a low risk of rejection and DSA development, even in patients with chronic allograft fibrosis.
  • Belatacept represents a potentially safe and effective alternative immunosuppressive strategy in this patient population, warranting further investigation.