Cardiovascular Risk Following Conversion to Belatacept From a Calcineurin Inhibitor in Kidney Transplant Recipients:...

Area of Science:

• Nephrology
• Cardiology
• Immunosuppression

Background:

• Belatacept-based immunosuppression may benefit cardiovascular (CV) risk factors in kidney transplant recipients (KTRs) compared to calcineurin inhibitors (CNIs).
• Validated models exist to assess CV risk in KTRs.

Purpose of the Study:

• To compare calculated CV risk between belatacept and CNI (predominantly tacrolimus) treatments in KTRs.
• To evaluate changes in traditional CV health markers and arterial stiffness.

Main Methods:

• Prospective, randomized, open-label, multicenter trial involving 105 KTRs.
• Participants continued CNI-based or switched to belatacept immunosuppression for 12 months.
• Assessed 7-year risk of major adverse CV events, all-cause mortality, CV risk factors, and arterial stiffness.

Main Results:

• No significant difference in predicted major adverse CV events or mortality risk between belatacept and CNI groups.
• Belatacept treatment led to lower central and peripheral diastolic blood pressure.
• The belatacept group experienced 4 acute rejection episodes, including 2 severe cases with 1 graft loss.

Conclusions:

• Switching to belatacept did not alter calculated CV risk in KTRs.
• Belatacept demonstrated a benefit in lowering diastolic blood pressure but was associated with a higher rate of acute rejection.
• Further research is needed to balance CV benefits against rejection risks.