Abstract: TH-PO830
Long-Term Outcomes Comparing Belatacept vs. Tacrolimus Stratified by Cytomegalovirus Risk in Kidney Transplant Recipients: A UNOS Database Analysis
Session Information
- Transplantation: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Montalvan, Adriana, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Canizares Quisiguina, Stalin Isaias, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Eckhoff, Devin, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Lee, David Donghyung, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Chopra, Bhavna, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Background
Cytomegalovirus (CMV) infection is associated with increased risk of death and significant morbidity which can cause graft loss. Some studies have shown that Belatacept (Bela) may be associated with an increased risk of CMV reactivation and infection. We analyzed the UNOS database to compare long term patient and graft outcomes comparing Tacrolimus (Tac) vs Bela based maintenance immunosuppression (IS) in Kidney Transplant Recipients (KTR) stratified by CMV risk.
Methods
Using the UNOS Standard Transplant Analysis and Research (STAR) file, we identified adult, kidney-only transplant recipients from 2010 to 2022 who received (depleting/non-depleting) induction therapy and were discharged on Tac or Bela based maintenance IS. Multivariate cox regression models adjusting for several donor, transplant and recipient factors were used to compare Tac vs Bela maintenance in KTR stratified by CMV risk; CMV low (D-/R-), CMV intermediate (R+), and CMV high risk (D+/R-). Outcome measures included overall mortality, graft, and death-censored graft failure (DCGF).
Results
A total of 196785 KTR were identified where 5046 were on Bela and 191739 on Tac at discharge. The long-term outcomes comparing Tac vs. Bela were similar in CMV low risk group, worse (DCGF and Patient) for Bela in CMV intermediate risk and DCGF was nearing significance worse for Bela in high-risk group. Results are shown in Table 1.
Conclusion
When stratifying KTR based on CMV risk, it appears that patients on maintenance Bela IS may be at increased risk for DCGF when the CMV risk increases. Lack of granularity of data on CMV infection related details, retrospective design and selection bias are limitations of this study.
Outcomes on KTR according to immunosuppression maintenance at discharge stratified by CMV risk
| Adjusted Overall Graft Failure HR (95%CI); p | Death Censored Graft Failure HR (95%CI); p | Patient Death HR (95%CI); p | |
| CMV Low Risk Tac (n=33035) vs Bela (n=866) | 1.04 (0.82-1.31); 0.749 | 1.31 (0.93-1.83); 0.123 | 1.06 (0.82-1.37); 0.661 |
| CMV Intermediate Risk Tac (n=124730) vs Bela (n=3423) | 0.99 (0.91-1.01); 0.890 | 0.83 (0.74-0.92); 0.001 | 0.89 (0.80-0.98); 0.015 |
| CMV High Risk Tac (n=33948) vs Bela (n=757) | 0.86 (0.73 - 1.02); 0.091 | 0.81 (0.65-1.01); 0.058 | 0.87 (0.71-1.05); 0.149 |
pos: positive | neg: negative