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Costimulatory Blockade and Use of mTOR Inhibitors: Avoiding Injury Part 2

David Wojciechowski1, Flavio Vincenti1

  • 1Division of Nephrology, Massachusetts General Hospital, Boston, MA; and Kidney Transplant Service, University of California, San Francisco, CA.

Advances in Chronic Kidney Disease
|October 16, 2016
PubMed

Insights

Calcineurin inhibitors improve early kidney transplant survival but not long-term. Belatacept offers better kidney function but higher rejection risk, prompting research into optimized calcineurin inhibitor-free regimens.

Area of Science:

  • Nephrology
  • Immunology
  • Transplantation Science

Background:

  • Kidney transplant immunosuppression traditionally uses calcineurin inhibitors (CNIs).
  • CNIs reduce early rejection but do not improve long-term graft survival and cause nephrotoxicity.
  • This necessitates exploring calcineurin inhibitor-free immunosuppressive strategies.

Purpose of the Study:

  • To evaluate belatacept, a CTLA4-Ig variant, in calcineurin inhibitor-free regimens for kidney transplantation.
  • To assess belatacept's efficacy in improving renal function and its associated rejection risks.
  • To explore belatacept's role in converting stable kidney transplant recipients from CNIs.

Main Methods:

  • Utilizing belatacept as part of a calcineurin inhibitor-free immunosuppressive regimen.
  • Comparing glomerular filtration rate (GFR) and rejection rates between belatacept and CNI groups.
  • Investigating belatacept conversion strategies in stable kidney transplant recipients.

Main Results:

  • Belatacept demonstrated superior glomerular filtration rate compared to calcineurin inhibitors.
  • Belatacept use was associated with an increased risk of early and severe acute rejection.
  • Conversion to belatacept in stable recipients improved GFR compared to CNI continuation.

Conclusions:

  • Belatacept offers improved renal function in kidney transplantation but requires careful management of rejection risk.
  • Optimizing belatacept regimens is crucial for reducing acute rejection while preserving superior renal function.
  • Belatacept shows promise for conversion strategies and potentially in managing allograft dysfunction.
Keywords:
BelataceptCostimulation blockadeRenal injurymTOR inhibitors

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