Belatacept Rescue Therapy in Kidney Transplant Recipients With Vascular Lesions: A Case Control Study

Area of Science:

• Nephrology
• Transplant Immunology
• Immunosuppression

Background:

• Managing immunosuppression in kidney transplant recipients with declining graft function and severe vascular damage presents significant challenges.
• Calcineurin inhibitors (CNIs) are standard but can contribute to nephrotoxicity and vascular complications.

Purpose of the Study:

• To evaluate the efficacy of switching from CNIs to belatacept as a rescue therapy in kidney transplant recipients with decreased graft function and histological vascular changes.
• To assess the impact of belatacept on estimated glomerular filtration rate (eGFR) in this specific patient population.

Main Methods:

• A retrospective case-control study comparing 17 patients switched from CNI to belatacept with 18 matched controls continuing CNI therapy.
• Patients in both groups had low eGFR and evidence of vascular damage at baseline.
• eGFR was monitored before, and at 6 and 12 months after the switch.

Main Results:

• The belatacept switch group showed a significant increase in mean eGFR from 23.5 to 30.4 mL/min/1.73m² at 6 months (p < 0.001), which remained significant at 12 months.
• No significant eGFR improvement was observed in the CNI continuation group.
• Two patients experienced acute rejection, one managed without belatacept cessation. Two patients discontinued belatacept due to infection.

Conclusions:

• Replacing CNIs with belatacept in kidney transplant recipients with compromised allograft function and vascular lesions is associated with improved eGFR.
• Belatacept can be a valuable rescue therapy option in challenging immunosuppression scenarios post-kidney transplantation.