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. 2023 Mar 15;18(3):e0281492.
doi: 10.1371/journal.pone.0281492. eCollection 2023.

Conversion to belatacept after lung transplantation: Report of 10 cases

Olivier Brugière  1 , Alexandre Vallée  2 , Quentin Raimbourg  3 , Marie-Noelle Peraldi  4 , Sylvie Colin de Verdière  1 , Laurence Beaumont  1 , Abdulmonem Hamid  1 , Mathilde Zrounba  1 , Antoine Roux  1 , Clément Picard  1 , François Parquin  5 , Matthieu Glorion  6 , Julie Oniszczuk  4 , Alexandre Hertig  4 , Hervé Mal  7 , Vincent Bunel  7
Affiliations

Conversion to belatacept after lung transplantation: Report of 10 cases

Olivier Brugière et al. PLoS One. .

Abstract

Background: Calcineurin inhibitors (CNIs) remain the cornerstone of maintenance immunosuppression (IS) after lung transplantation (LTx), although CNI-related life-threatening toxic effects may occur. Belatacept, a novel immunosuppressant that blocks a T-cell co-stimulation pathway, is a non-nephrotoxic drug indicated as an alternative to CNIs in kidney Tx. In LTx, there are only a few reports of belatacept conversion as a CNI-free or CNI-sparing IS treatment.

Methods: We reviewed a series of 10 LTx recipients with conversion to a CNI-free belatacept IS regimen within the first year post-LTx (n = 7) or a belatacept/low-dose CNI combination after the first year (n = 3).

Results: Use of belatacept was triggered by severe renal failure in 9 patients and under-IS with previous other IS-related toxicities in 1 patient. Mean estimated glomerular filtration rate after starting belatacept significantly improved at 6 months after initiation and at the last-follow-up (p = 0.006, and p = 0.002 respectively). The incidence of recurrent and/or severe acute cellular rejection (ACR) episodes was high in patients with CNI-free belatacept-based IS (n = 4/7). Chronic graft allograft dysfunction developed in 2 of 9 recipients under belatacept IS. Belatacept was stopped in 6 patients because of recurrent/severe ACR (n = 3), recurrent opportunistic infections (n = 1), center modified policy (n = 1), or other cause (n = 1).

Conclusion: Early conversion to CNI-free belatacept-based IS improved renal function in this series but was counterbalanced by a high incidence of recurrent ACR, including life-threatening episodes. Other studies are needed to better determine the indications for its use after LTx, possibly with lower immunological risk IS regimens, such as CNI-sparing belatacept.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Post-LTx outcome of individual blood creatinine values in the 10 patients before starting belatacept, from day 0 (D0) of transplantation to the day of conversion to belatacept.
Fig 2
Fig 2
A: Outcome of individual serum creatinine clearance values in the 10 patients after starting belatacept, from day 0 of belatacept to last follow-up under belatacept; B: Outcome of individual forced expiratory in 1 second (FEV1) values for patients after starting belatacept from day 0 to last follow-up.
See this image and copyright information in PMC

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