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Multicenter Study
. 2024 Dec 6:37:13544.
doi: 10.3389/ti.2024.13544. eCollection 2024.

Biopsy-Proven T-Cell Mediated Rejection After Belatacept Rescue Conversion: A Multicenter Retrospective Study

Dominique Bertrand  1 , Nathalie Chavarot  2 , Jérôme Olagne  3 , Clarisse Greze  4 , Philippe Gatault  5 , Clément Danthu  6 , Charlotte Colosio  7 , Maïté Jaureguy  8 , Agnès Duveau  9 , Nicolas Bouvier  10 , Yannick Le Meur  11 , Léonard Golbin  12 , Eric Thervet  13 , Antoine Thierry  14 , Arnaud François  15 , Charlotte Laurent  1 , Mathilde Lemoine  1 , Dany Anglicheau  2 , Dominique Guerrot  1
Affiliations
Multicenter Study

Biopsy-Proven T-Cell Mediated Rejection After Belatacept Rescue Conversion: A Multicenter Retrospective Study

Dominique Bertrand et al. Transpl Int. .

Abstract

After kidney transplantation, conversion to belatacept is a promising alternative in patients with poor graft function or intolerance to calcineurin inhibitors. The risk of acute rejection has not been well described under these conditions. Here we present a retrospective multicenter study investigating the occurrence of acute rejection after conversion in 901 patients (2011-2021). The incidence of cellular and humoral rejection was 5.2% and 0.9%, respectively. T-cell mediated rejection (TCMR) occurred after a median of 2.6 months after conversion. Out of 47 patients with TCMR, death-censored graft survival was 70.1%, 55.1% and 50.8% at 1 year, 3 years and 5 years post-rejection, respectively. Eight patients died after rejection, mainly from infectious diseases. We compared these 47 patients with a cohort of kidney transplant recipients who were converted to belatacept between 2011 and 2017 and did not develop rejection (n = 238). In multivariate analysis, shorter time between KT and conversion, and the absence of anti-thymocyte globulin induction after KT were associated with the occurrence of TCMR after belatacept conversion. The occurrence of rejection after conversion to belatacept appeared to be less frequent than with de novo use. Nevertheless, the risk of graft loss could be significant in patients with already low renal function.

Keywords: CNI toxicity; belatacept; kidney; rejection; transplantation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart. KTRs, kidney transplant recipients; ABMR, antibody-mediated rejection; TCMT, T cell-mediated rejection.
See this image and copyright information in PMC

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