One-Year Outcomes After Belatacept Conversion in Adolescent Kidney Transplant Recipients

Area of Science:

• Nephrology
• Immunology
• Pediatric Medicine

Background:

• Belatacept (CTLA4-Ig) demonstrates efficacy in adult kidney transplantation (KT), improving survival and reducing donor-specific antibodies (DSA).
• Adolescents with KT face higher graft loss risk due to nonadherence, prompting interest in belatacept's long-term benefits and administration schedule.
• Limited data exists on belatacept use in pediatric KT recipients.

Purpose of the Study:

• To evaluate the 1-year outcomes of adolescents converted from calcineurin inhibitors (CNIs) to belatacept.
• To compare outcomes between adolescents on belatacept and a propensity-matched cohort remaining on CNIs.

Main Methods:

• A multicenter retrospective study involving 45 adolescents who switched from CNIs to belatacept between 2018 and 2021.
• Indications for conversion included CNI toxicity, suboptimal renal function, or adherence issues.
• One-year outcomes were compared with a propensity-matched cohort on CNIs.

Main Results:

• Rejection occurred in 24% of patients on belatacept; rates did not differ significantly from the CNI group.
• Patients on belatacept without rejection showed a significant increase in estimated glomerular filtration rate (eGFR) (+19%).
• No increased infectious complications were observed with belatacept use.

Conclusions:

• Rejection rates in adolescents on belatacept were comparable to those on CNIs, highlighting adherence challenges in this population.
• Belatacept may offer benefits for selected adolescents, particularly those without rejection, showing improved kidney function.
• Further research is needed to identify optimal patient selection criteria for belatacept in pediatric KT.