Abstract: SA-PO002
One Year Kidney Transplant Outcomes Using Belatacept and Sirolimus Maintenance Immunosuppression
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Traynor, Carol A., Duke University, Durham, North Carolina, United States
- Kirk, Allan D., Duke University School of Medicine, Durham, North Carolina, United States
Background
Calcineurin inhibitors (CNIs) are the cornerstone of immunosuppression fafter kidney transplantation, but are associated with adverse events when used long term. Belatacept, a CTLA4-Ig fusion protein, is a costimulation blocker that prevents T-lymphocyte activation. It provides effective immunosuppression post kidney transplant and allows CNI free immunosuppression. Typical regimens include belatacept with mycophenolate mofetil and steroids, and have been associated with higher acute rejection rates than CNI based regimens. We describe our experience using a belatacept and sirolimus based maintenance immunosuppression regimen.
Methods
This is a retrospective analysis of patients treated with belatacept maintenance therapy at a single center. Patients were eligible for belatacept if: age<70, BMI<35, EBV IgG positive, no donor specific antibody. They received alemtuzumab induction (30 mg, intravenously), infusion of belatacept (10mg/Kg Day 0,4 and end of week 2,4,8, and 12; then 5 mg/kg every month, and oral sirolimus 2mg daily, dose adjusted for 24-hour trough 8-10ng/ml.
Results
Baseline demographics are outlined in table 1. There was 100% patient and graft survival at one year. There was no delayed graft function. Acute rejection occurred in 13.6%. Median GFR at one year was 55ml/minute. Median protein/creatinine ratio was 262 mg/g Creatinine. There were 25 infections in 13 patients. There were 9 viral infections. CMV and BK virus occurred at a rate of 13.6% and 13.6%, respectively. There were 10 bacterial infections-the majority (80%) were urinary tract infections. There were 6 fungal infections-all were mucocutaneous infections. There were no cases of post transplant lymphoproliferative disease.
Conclusion
A combination of costimulation blockade with belatacept, alemtuzumab induction and daily sirolimus enables use of a CNI and steroid free maintenance immunosuppression regimen in select patients. There were excellent one-year graft outcomes, and it was well tolerated with an acceptable side effect profile. Longer follow up is needed.
Baseline Demographics
| Demographic | |
| Age (mean) | 51 years |
| Gender (Male) | 68.2% |
| Race African american Other | 18.2% 82.8% |
| Donor Type Living Related Living Unrelated Deceased | 50% 45.5% 4.5% |
| Panel Reactive Antibody at time of transplant (mean) Class I Class II | 4.4% 7.2% |