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Biopsy-Proven T-Cell Mediated Rejection After Belatacept Rescue Conversion: A Multicenter Retrospective Study.

Dominique Bertrand1, Nathalie Chavarot2, Jérôme Olagne3

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Converting to belatacept after kidney transplant is a viable option. Acute rejection, particularly T-cell mediated rejection (TCMR), can occur, impacting long-term graft survival.

Keywords:
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Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • Belatacept offers an alternative for kidney transplant recipients with poor graft function or calcineurin inhibitor intolerance.
  • The risk of acute rejection following belatacept conversion requires further characterization.

Purpose of the Study:

  • To investigate the incidence and outcomes of acute rejection after belatacept conversion in kidney transplant patients.
  • To identify risk factors associated with T-cell mediated rejection (TCMR) post-conversion.

Main Methods:

  • Retrospective multicenter study of 901 kidney transplant recipients converted to belatacept between 2011-2021.
  • Comparison of patients with TCMR to a control group without rejection.
  • Multivariate analysis to identify risk factors for TCMR.

Main Results:

  • Incidence of cellular rejection was 5.2%, and humoral rejection was 0.9%.
  • TCMR occurred at a median of 2.6 months post-conversion, with significant long-term graft loss.
  • Shorter time from kidney transplant to conversion and lack of anti-thymocyte globulin induction were associated with TCMR.

Conclusions:

  • Acute rejection after belatacept conversion is less frequent than with de novo use but carries significant risks.
  • Patients experiencing TCMR face substantial risks of graft loss and mortality, often due to infections.
  • Careful patient selection and monitoring are crucial for those converted to belatacept, especially those with compromised graft function.