CMV high-risk status and posttransplant outcomes in kidney transplant recipients treated with belatacept

Am J Transplant. 2021 Jan;21(1):208-221. doi: 10.1111/ajt.16132. Epub 2020 Aug 8.

Abstract

Introduction: Cytomegalovirus (CMV) remains associated with poor outcomes after kidney transplantation (kTx). The impact of belatacept on CMV infection remains understudied. In this study, we assessed the impact of belatacept on patient and graft survivals.

Methods: CMV seronegative kTx recipients were included. Patient and graft survival were studied using Kaplan-Meier method, log-rank test. Cox models were used to compare outcomes by CMV risk and immunosuppressive regimen. Incidence and persistence of CMV viremia under belatacept vs tacrolimus were compared.

Results: Among 308 CMV seronegative recipients, 168 CMV high-risk and 203 belatacept-treated patients were included. High-risk CMV status was associated with lower patient survival and graft survival. Among the CMV high-risk group, patients treated with belatacept presented a higher incidence of CMV viremia, a higher rate of first-line treatment failure and a longer time to virus clearance. They had a nonsignificant trend toward a lower graft survival.

Conclusion: Belatacept-based maintenance immunosuppression is associated with an increased risk of CMV primary-infection and a prolonged course of viral replication in CMV high-risk patients. Further studies are needed to confirm the nonsignificant trend towards a lower graft survival in CMV high-risk patients treated with belatacept and whether it is explained by the higher risk of CMV reactivation and infection.

Keywords: clinical research/practice; complication: infectious; immunosuppressant - fusion proteins and monoclonal antibodies: belatacept; immunosuppression/immune modulation; immunosuppressive regimens - maintenance; infection and infectious agents - viral: Cytomegalovirus (CMV); infectious disease; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; translational research/science.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abatacept / therapeutic use
  • Cytomegalovirus Infections* / drug therapy
  • Cytomegalovirus Infections* / epidemiology
  • Graft Rejection / drug therapy
  • Graft Rejection / etiology
  • Graft Rejection / prevention & control
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Transplantation* / adverse effects
  • Risk Factors
  • Transplant Recipients

Substances

  • Immunosuppressive Agents
  • Abatacept