Switching renal transplant recipients to belatacept therapy: results of a real-life gradual conversion protocol.
Abatacept
/ therapeutic use
Acute Disease
Adult
Aged
B-Lymphocytes
/ immunology
Biomarkers
/ urine
Calcineurin Inhibitors
/ therapeutic use
Chemokine CXCL9
/ urine
Drug Dosage Calculations
Drug Substitution
Female
Follow-Up Studies
Graft Rejection
/ diagnosis
Humans
Immunologic Memory
Immunosuppressive Agents
/ therapeutic use
Kidney Transplantation
Male
Middle Aged
Retrospective Studies
T-Lymphocytes
/ immunology
Transplant Recipients
Belatacept
CXCL9
Conversion
Renal transplant
Tacrolimus
Journal
Transplant immunology
ISSN: 1878-5492
Titre abrégé: Transpl Immunol
Pays: Netherlands
ID NLM: 9309923
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
22
02
2019
revised:
18
04
2019
accepted:
26
04
2019
pubmed:
10
5
2019
medline:
4
4
2020
entrez:
10
5
2019
Statut:
ppublish
Résumé
Conversion to belatacept immunosuppression is a therapeutic option for renal-transplant recipients with calcineurin inhibitors (CNI) toxicity, but it associates with high risk of acute rejection. Gradual conversion and serial immune monitoring with urinary chemokine CXCL9 may allow increasing safety of this maneuver. We converted kidney transplant recipients with signs of toxicity to CNI or other immunosuppressive drugs to belatacept over a 2-month period. We monitored renal function, metabolic profile, and circulating lymphocyte subsets. We also quantified urinary CXCL9 over a 12-month follow-up period. Between September 2016 and March 2017, 35 patients were successfully switched to belatacept immunosuppression at 3.3 (1.3-7.2) years after transplant. Two patients had a reversible rise in serum creatinine, associated with acute rejection in one case. Urinary CXCL9 increased before serum creatinine. After conversion, blood pressure and HbA1c significantly declined while eGFR and proteinuria remained stable. The percentage of circulating effector T cells and memory B cells significantly declined. Conversion from CNI to belatacept, in this setting, was feasible and safe, provided it was performed over a 2-month time-period. Monitoring urinary CXCL9 may further increase safety through earlier identification of patients at risk for acute rejection. The procedure associates with improved blood pressure, metabolic profile, and reduced circulating effector T and B cells.
Identifiants
pubmed: 31071442
pii: S0966-3274(19)30023-1
doi: 10.1016/j.trim.2019.04.002
pii:
doi:
Substances chimiques
Biomarkers
0
CXCL9 protein, human
0
Calcineurin Inhibitors
0
Chemokine CXCL9
0
Immunosuppressive Agents
0
Abatacept
7D0YB67S97
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
101207Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.