Time-Limited Therapy with Belatacept in Kidney Transplant Recipients

Journal of Clinical Medicine

on behalf of the Divat Consortium¹  Abderrahmane Sadek²  Victor Gourain³  Cynthia Fourgeux³  Jeremie Poschmann³  Delphine Kervella⁴  Christophe Masset⁴  Claire Garandeau⁴  Thibault Letellier⁴  Simon Ville⁴  Gilles Blancho⁴ 

[1] ;Biotechnology and Bio Resources Development Laboratory, Faculty of Sciences, Moulay Ismail University, Meknes 50050, Morocco;CR2TI-U1064 The Center for Research in Transplantation and Translational Immunology, Université de Nantes, 44000 Nantes, France;Institut de Transplantation Urologie Néphrologie (ITUN), Centre Hospitalo-Universitaire Nantes, 44000 Nantes, France;

关键词: kidney transplantation;    belatacept;    calcineurin inhibitor;    transcriptome;    RNAseq;   

DOI  :  10.3390/jcm11113229

来源: DOAJ

【 摘 要 】

Introduction: In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit–risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results are analyzed in that study. Methods: We considered all the kidney transplant recipients that had been switched from conventional immunosuppressive therapy to belatacept and then for whom belatacept has been withdrawn intentionally. Furthermore, in the first 8 patients, we assessed changes in peripheral blood mononuclear cells (PBMC) transcriptome using RNAseq before and 3 months after belatacept withdrawal. Results: Over the study period, 28 out of 94 patients had belatacept intentionally withdrawn including 25 (89%) switched to low-dose CNI. One rejection due to poor compliance occurred. The eGFR after 12 months remained stable from 48 ± 19 mL.1.73 m⁻² to 46 ± 17 mL.1.73 m⁻² (p = 0.68). However, patients that resumed belatacept/withdrew CNIs (n = 10) had a trend towards a better eGFR comparing with the others (n = 15): 54 ± 20 mL.1.73 m⁻² vs. eGFR 43 ± 16 mL.1.73 m⁻², respectively (p = 0.15). The only factor associated with belatacept resumption was when the withdrawal took place during the COVID-19 outbreak. Transcriptome analysis of PBMCs, did not support rebound in alloimmune response. Conclusions: These findings underpin the use of belatacept as part of a time-limited therapy, in selected kidney transplant recipients, possibly as an approach to allow efficient vaccination against SARS-CoV-2.

【 授权许可】

Unknown