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Belatacept Conversion in Kidney After Liver Transplantation
Octav Cristea1,2, Geeta Karadkhele2, William H Kitchens1,2
1Department of Surgery, Emory University Hospital, Atlanta, GA.
Transplantation Direct
|October 29, 2021
Summary
Belatacept conversion in liver transplant recipients needing kidney transplants shows promise for calcineurin inhibitor (CNI)-free immunosuppression. This strategy avoids CNI toxicity and improves outcomes in liver transplant patients.
Area of Science:
- Immunology
- Transplantation Medicine
- Nephrology
Background:
- Belatacept offers long-term benefits in kidney transplants but has shown risks in de novo liver transplant use.
- Calcineurin inhibitors (CNIs) can cause renal dysfunction and toxicity, limiting outcomes in liver transplant recipients.
- Belatacept conversion as a CNI avoidance strategy in liver transplantation remains unstudied.
Purpose of the Study:
- To evaluate the safety and efficacy of belatacept-based immunosuppression in liver transplant recipients undergoing subsequent kidney transplantation.
- To assess belatacept's potential as a CNI avoidance strategy in liver transplant recipients.
Main Methods:
- Retrospective analysis of clinical data from 8 patients who received kidney after liver transplants.
- Patients were treated with belatacept-based immunosuppression and temporary CNI therapy.
Main Results:
- All 8 patients tolerated belatacept without death or graft loss.
- No rejection, de novo donor-specific antibody formation, or serious infections occurred.
- Excellent liver and renal allograft function was maintained; 6 of 8 patients continued belatacept, with 3 CNI-free at follow-up.
Conclusions:
- Belatacept-based therapy may facilitate CNI-free maintenance immunosuppression in liver transplant recipients requiring kidney transplants.
- This study suggests belatacept conversion is a viable CNI avoidance strategy for liver transplant recipients.
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