Retrospective evaluation of the efficacy and safety of belatacept with thymoglobulin induction and maintenance everolimus: A single-center clinical experience

Clin Transplant. 2017 Sep;31(9). doi: 10.1111/ctr.13042. Epub 2017 Jul 21.

Abstract

Belatacept use has been constrained by higher rates of acute rejection. We hypothesized that belatacept with low-dose rATG and initial mycophenolate maintenance with conversion to everolimus at 1 month post-transplant ± corticosteroids would improve efficacy and maintain safety. Retrospective single-center analysis of the first 44 low immunologic risk kidney transplant recipients treated with this regimen. The cohort was 59% male, mean age at transplant of 57 years. Diabetes was the most common cause of ESRD (39%). The mean 1-year eGFR was 61.4 (SD 18.4) mL/min/1.73 m2 . There were five acute cellular rejections (11.4%) that occurred in patients who had changed from everolimus to mycophenolate mofetil due to side effects. Thirty-two percent developed BK viremia and 12% developed CMV viremia. There were no cases of PTLD. A novel belatacept regimen with rATG induction and maintenance everolimus demonstrated a low acute rejection rate and maintained an excellent 1-year eGFR.

Keywords: Fusion proteins: belatacept, immunosuppressant; Immunosuppressant; mechanistic target of rapamycin: everolimus, immunosuppressive regimens.

Publication types

  • Evaluation Study

MeSH terms

  • Abatacept / therapeutic use*
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Antilymphocyte Serum / therapeutic use*
  • Drug Therapy, Combination
  • Everolimus / therapeutic use*
  • Female
  • Follow-Up Studies
  • Graft Rejection / prevention & control*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Induction Chemotherapy / methods*
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation
  • Maintenance Chemotherapy / methods*
  • Male
  • Middle Aged
  • Mycophenolic Acid / therapeutic use
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Antilymphocyte Serum
  • Immunosuppressive Agents
  • Abatacept
  • Everolimus
  • thymoglobulin
  • Mycophenolic Acid