Comparison of Outcomes Between Obese and Non-Obese Pancreas Transplant Recipients Following Belatacept Conversion

Calcineurin inhibitors are the standard backbone of maintenance immunosuppression following pancreas transplantation but cause metabolic toxicities, such as diabetes. Belatacept has been demonstrated to improve kidney allograft function following kidney transplantation but has not been well studied in pancreas transplantation. Belatacept pharmacokinetic data demonstrate increasing drug clearance with higher body weight. The purpose of this study is to compare outcomes of obese versus non-obese pancreas transplant recipients following belatacept conversion.

This was a case series of patients who underwent pancreas transplantation converted to belatacept. The primary outcome was the need for insulin usage post-belatacept conversion.

There was a higher incidence of insulin usage in the obese versus non-obese groups (80% vs 16.7%, p = .036). The incidence of allograft rejection was similar between the obese and non-obese groups (20% vs 33.3%, p = .621). There was also no difference in the incidence of de novo DSA development between groups (20% vs 33.3%, p = .621). There was no statistically significant difference between allograft function, represented by median GFR (38.9 vs 62, p = .361) and HbA1c (4.9% vs 5.3%, p = .593) between the obese and non-obese pancreas transplant recipients. Both groups demonstrated an improvement of HbA1c from pre-transplant (-2.15% vs -4.55%, p = .055).

All patients had an improvement in HbA1c post-pancreas transplant; however, there were more patients requiring insulin in the obese group. Acute rejection, de novo DSA development, GFR and HbA1c 6-months post-conversion, and infectious complications were similar between the groups. Larger studies are warranted to assess the safety and efficacy of belatacept use post-pancreas transplantation.