De novo donor specific antibody (dnDSA) development with tacrolimus versus Belatacept based regimens in kidney...

Belatacept has been associated with less de novo specific antibody (dnDSA) development, but few publications have compared the incidence of dnDSA development between tacrolimus and belatacept-based immunosuppression regimens. The purpose of this study was to investigate the differences in dnDSA development and clinical outcomes between these two maintenance regimens in kidney transplant.

This was a retrospective, single center, cohort study of patients transplanted between 2013 and 2019 who received a de novo belatacept or tacrolimus-based immunosuppression regimen. The primary outcome was the incidence of dnDSA development (MFI ≥ 1000) at 36 months. Secondary outcomes included renal function, biopsy proven rejection (BPAR), and patient/graft survival.

Ninety patients met inclusion criteria. The primary outcome occurred in 4 (8.9 %) belatacept patients and 6 (13.3 %) tacrolimus patients, with an overall median time to dnDSA of 300 days (p = 0.51). Class II dnDSA development occurred in 3 (6.7 %) belatacept patients and 6 (13.3 %) tacrolimus patients. Belatacept patients had a lower, but not significantly different, rate of developing BPAR (4.4 % vs 13.3 %, p = 0.13) and had superior renal function at 36 months (median 66 ml/min vs 53 ml/min, p < 0.01). Overall, there was excellent patient/graft survival at 36 months post-transplant.

De novo belatacept use did not result in a statistically significant difference in the development of dnDSAs but did show a numerically lower class II dnDSA and BPAR development. Overall, belatacept was associated with improved renal function as compared to tacrolimus-based regimens.