Opportunistic Infections and Efficacy Following Conversion to Belatacept-Based Therapy after Kidney Transplantation: A French Multicenter Cohort

Journal of Clinical Medicine

Nathalie Chavarot¹  Rebecca Sberro¹  Isabelle Etienne²  Dominique Bertrand²  Maïté Jaureguy³  Johnny Sayegh⁴  Anne Grall-Jezequel⁵  Nicolas Bouvier⁶  Cyril Garrouste⁷  Eric Thervet⁸  Jean-Philippe Rerolle⁹  Antoine Thierry^1,10  Charlotte Colosio^1,11  Leonard Golbin^1,12  Sophie Caillard^1,13  Philippe Gatault^1,14  Thomas Jouve^1,15  Paolo Malvezzi^1,15  Johan Noble^1,15  Bénédicte Janbon^1,15  Florian Terrec^1,15  Lionel Rostaing^1,15 

[1] Department of Adult Kidney Transplantation, Necker-Enfants Malades University Hospital, 75000 Paris, France;Department of Nephrology and Transplantation, Rouen University Hospital, 76000 Rouen, France;Department of Nephrology, Amiens University Hospital, 80000 Amiens, France;Department of Nephrology, Angers University Hospital, 49000 Angers, France;Department of Nephrology, Brest University Hospital, 28200 Brest, France;Department of Nephrology, Caen University Hospital, 14000 Caen, France;Department of Nephrology, Clermont Ferrand University Hospital, 63000 Clermont Ferrand, France;Department of Nephrology, European Georges Pompidou University Hospital, 75000 Paris, France;Department of Nephrology, Limoges University Hospital, 87000 Limoges, France;Department of Nephrology, Poitiers University Hospital, 86000 Poitiers, France;Department of Nephrology, Reims University Hospital, 51100 Reims, France;Department of Nephrology, Rennes University Hospital, 35000 Rennes, France;Department of Nephrology, Strasbourg University Hospital, 67000 Strasbourg, France;Department of Nephrology, Tours University Hospital, 37000 Tours, France;Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, 38000 Grenoble, France;

关键词: kidney transplantation;    belatacept;    tacrolimus;    opportunistic infections;    CMV infection;    pneumocystis pneumonia;   

DOI  :  10.3390/jcm9113479

来源: DOAJ

【 摘 要 】

Conversion from calcineurin-inhibitors (CNIs) to belatacept can help kidney-transplant (KT) recipients avoid CNI-related nephrotoxicity. The risk of associated opportunistic infections (OPIs) is ill-defined. We conducted a multicentric cohort study across 15 French KT-centers in a real-life setting. Between 07-2010 and 07-2019, 453 KT recipients were converted from CNI- to belatacept-based therapy at 19 [0.13–431] months post-transplantation. Most patients, i.e., 332 (79.3%), were converted after 6-months post-transplantation. Follow-up time after conversion was 20.1 +/− 13 months. OPIs developed in 42(9.3%) patients after 14 +/− 12 months post-conversion. Eight patients (19%) had two OPI episodes during follow-up. Incidences of CMV DNAemia and CMV disease were significantly higher in patients converted before 6-months post-KT compared to those converted later (i.e., 31.6% vs. 11.5%; p < 0.001; and 11.6% vs. 2.4%, p < 0.001, respectively). Cumulative incidence of OPIs was 6.5 OPIs/100 person–years. Incidence of CMV disease was 2.8/100 person–years, of pneumocystis pneumonia 1.6/100 person–years, and of aspergillosis 0.2/100 person–years. Multivariate analyses showed that estimated glomerular filtration (eGFR) < 25 mL/min/1.73 m² at conversion was independently associated with OPIs (HR = 4.7 (2.2 − 10.3), p < 0.001). The incidence of EBV DNAemia was 17.3 events /100 person–years. At 1-year post-conversion, mean eGFR had significantly increased from 32.0 +/− 18 mL/min/1.73 m² to 42.2 +/− 18 mL/min/1.73 m² (p < 0.0001). Conversion to belatacept is an effective strategy with a low infectious risk.

【 授权许可】

Unknown