TY - JOUR
T1 - Alemtuzumab induction and belatacept maintenance in marginal pathology renal allografts
AU - Sparkes, Tracy
AU - Ravichandran, Bharath
AU - Opara, Onumara
AU - Ugarte, Richard
AU - Drachenberg, Cinthia B.
AU - Philosophe, Benjamin
AU - Bromberg, Jonathan S.
AU - Barth, Rolf N.
N1 - Funding Information:
Bristol-Myers Squibb provided funding for this study.
Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2019/6
Y1 - 2019/6
N2 - We performed a prospective, 12-month, single-center, nonrandomized, open-label pilot study to investigate the use of belatacept therapy combined with alemtuzumab induction in renal allografts with preexisting pathology, as these kidneys may be more susceptible to additional toxicity when exposed to calcineurin inhibitors posttransplant. Nineteen belatacept recipients were matched retrospectively to a cohort of tacrolimus recipients on the basis of preimplantation pathology. The estimated glomerular filtration rate was not significantly different between belatacept and tacrolimus recipients at either 3 or 12 months posttransplant (59 vs 45, P = 0.1 and 56 vs 48 mL/min/1.72/m2, P = 0.3). Biopsy-proven acute rejection rates at 12 months were 26% in belatacept recipients and 16% in tacrolimus recipients (P = 0.7). Graft survival at 1 year was 89% in both groups. Alemtuzumab induction combined with either calcineurin inhibitor or costimulatory blockade therapies resulted in similar acceptable one-year outcomes in kidneys with preexisting pathologic changes. Longer-term follow-up may be necessary to identify preferential strategies to improve outcomes of kidneys at a higher risk for poor function (ClinicalTrials.gov—NCT01496417).
AB - We performed a prospective, 12-month, single-center, nonrandomized, open-label pilot study to investigate the use of belatacept therapy combined with alemtuzumab induction in renal allografts with preexisting pathology, as these kidneys may be more susceptible to additional toxicity when exposed to calcineurin inhibitors posttransplant. Nineteen belatacept recipients were matched retrospectively to a cohort of tacrolimus recipients on the basis of preimplantation pathology. The estimated glomerular filtration rate was not significantly different between belatacept and tacrolimus recipients at either 3 or 12 months posttransplant (59 vs 45, P = 0.1 and 56 vs 48 mL/min/1.72/m2, P = 0.3). Biopsy-proven acute rejection rates at 12 months were 26% in belatacept recipients and 16% in tacrolimus recipients (P = 0.7). Graft survival at 1 year was 89% in both groups. Alemtuzumab induction combined with either calcineurin inhibitor or costimulatory blockade therapies resulted in similar acceptable one-year outcomes in kidneys with preexisting pathologic changes. Longer-term follow-up may be necessary to identify preferential strategies to improve outcomes of kidneys at a higher risk for poor function (ClinicalTrials.gov—NCT01496417).
KW - Immunosuppressant
KW - donors and donation: extended criteria
KW - fusion proteins and monoclonal antibodies: alemtuzumab
KW - fusion proteins and monoclonal antibodies: belatacept
KW - kidney (allograft) function/dysfunction
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U2 - 10.1111/ctr.13531
DO - 10.1111/ctr.13531
M3 - Article
C2 - 30866104
AN - SCOPUS:85068041551
VL - 33
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 6
M1 - e13531
ER -