Belatacept Conversion in Kidney Transplant Recipients for Prolonged DGF.

Abstract

Introduction Prolonged delayed graft function (PDGF), which we define as need for HD or a serum creatinine >2 mg/dL >14 days post-transplant, has a negative impact on long-term graft outcome. Tacrolimus may prolong PDGF. We investigated belatacept conversion from tacrolimus as a novel treatment strategy for PDGF. Methods Retrospective single center analysis of the first 11 patients converted to belatacept for PDGF (Group 1) compared to a historical control group of 22 PDGF patients who remained on tacrolimus (Group 2) matched for type of kidney transplant, cause of ESRD, and CIT. A renal allograft biopsy was done to rule out rejection as a cause of PDGF. Included patients demonstrated only acute tubular necrosis on their biopsies. Objectives: compare eGFR and rates of acute rejection and infection during the first 6 months post-transplant. Results Demographic and transplant characteristics were similar.Table: No Caption available.Biopsies to evaluate PDGF occurred on mean POD (SD) 36 (15.7) and 20.2 (19.8) for Groups 1 and 2, respectively (P = 0.03). Mean POD of belatacept conversion was 45.6 (range 18-74). Mean number of HD treatments (SD) for Groups 1 and 2 were 10.7 (10.7) and 13 (7.3), respectively (P = 0.47). Mean eGFR mL/min/1.73m2 (SD) for Groups 1 and 2 were 52.8 (31.6) and 47.2 (24.6; P = 0.59) at 3-months and 59.6 (26.7) and 47.4 (21; P = 0.19) at 6-months post-transplant, respectively. One Banff type 2a clinical rejection occurred in a patient in Group 2; subclinical rejection occurred in 3 patients in Group 1 (all type 1a) and 3 patients in Group 2 (1 type 1a and 2 type 2a). Infectious events were similar. Conclusion Belatacept conversion for PDGF is a novel strategy that resulted in a numerically higher eGFR at 6 months post-transplant compared to a tacrolimus historical control group. Expansion of this cohort with longer follow-up is necessary to further define the efficacy and safety of this strategy. DISCLOSURES:Wojciechowski, D.: Grant/Research Support, BMS. Chandran, S.: Grant/Research Support, BMS. Vincenti, F.: Grant/Research Support, BMS.