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Belatacept Conversion in Kidney Transplant Recipients with Congestive Heart Failure: Survival and 30-Day Readmission
Harshitha Mogallapalli1, Fauzia Osman1, Sandesh Parajuli1
1Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Insights
Converting kidney transplant recipients with heart failure from calcineurin inhibitors (CNIs) to belatacept showed similar survival and readmission rates. However, belatacept conversion increased the risk of rejection, necessitating closer patient monitoring.
Area of Science:
- Nephrology
- Cardiology
- Immunosuppression
Background:
- Calcineurin inhibitors (CNIs) increase cardiovascular risk in kidney transplant recipients (KTRs).
- Limited data exist on belatacept's impact in KTRs with congestive heart failure (CHF).
- Cardiovascular complications are a leading cause of mortality in KTRs.
Purpose of the Study:
- To evaluate the impact of converting from CNIs to belatacept on patient and graft survival in KTRs with CHF.
- To assess 30-day post-discharge readmission rates after CHF hospitalization in KTRs.
- To compare the safety and efficacy of belatacept versus continued CNI use in this population.
Main Methods:
- Retrospective analysis of KTRs admitted for CHF between 2014 and 2019.
- Matching 28 recipients who converted to belatacept with 339 who continued CNIs.
- Statistical analysis using adjusted hazard ratios to compare outcomes.
Main Results:
- No significant differences in patient survival, graft survival, or 30-day readmission rates between belatacept and CNI groups.
- Belatacept conversion was associated with a significantly higher risk of rejection (aHR, 13.8).
- Demographics and primary kidney disease were similar between groups.
Conclusions:
- Conversion to belatacept did not improve patient/graft survival or reduce readmissions in KTRs with CHF compared to CNIs.
- Increased rejection incidence in the belatacept group highlights the need for vigilant monitoring.
- Belatacept may be a viable alternative for select KTRs with CHF, but requires careful management.
Abstract:
Calcineurin inhibitors (CNIs) are deleterious to cardiovascular risk in kidney transplant recipients (KTRs). Data on the impact of belatacept on KTRs with congestive heart failure (CHF) are scarce. We hypothesized that conversion to belatacept will have better patient and graft survival and a lower rate of readmissions within 30 days after discharge compared with long-term CNI use. We analyzed data from KTRs admitted to CHF between 2014 and 2019. A total of 28 recipients converted to belatacept and were matched with 339 who continued on CNIs. There was no significant difference in patient demographics, or primary disease between the two groups. The adjusted hazard ratio associated with conversion was (0.87 [95% CI, 0.35-2.11] for death, (0.91, [95% CI, 0.39-2.13] for graft failure and (adjusted hazard ratio, 1.91, [95% confidence interval (CI), 0.90-4.06]) for 30-day postdischarge readmission between the two groups. Patients converted to belatacept were at a higher risk of rejection (adjusted hazard ratio, 13.8; 95% CI, 7.48-25.3). Patient and graft survival and 30-day readmission after CHF hospital discharge did not differ significantly between belatacept conversion and CNI continuation. The incidence of rejection was higher in the belatacept conversion group, suggesting a need for closer follow-up of patients on belatacept therapy.
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