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2018 ; 2018
(ä): 1968029
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Pilot Analysis of Late Conversion to Belatacept in Kidney Transplant Recipients
for Biopsy-Proven Chronic Tacrolimus Toxicity
#MMPMID29854421
Gupta S
; Rosales I
; Wojciechowski D
J Transplant
2018[]; 2018
(ä): 1968029
PMID29854421
show ga
BACKGROUND: Calcineurin inhibitors are associated with chronic nephrotoxicity,
manifesting as interstitial fibrosis/tubular atrophy (IF/TA) and arteriolar
hyalinosis. Conversion from tacrolimus to belatacept may be one strategy to
preserve renal function. METHODS: We conducted a retrospective review of renal
transplant patients followed at our institution who were converted to belatacept
and found to have chronic tacrolimus toxicity on biopsy. The primary outcome was
eGFR at conversion as compared to eGFR at 3, 6, 12, and 24 months after
conversion. We also assessed incidence of infection and rates of allograft
survival at 1 year. RESULTS: The average time between transplant and conversion
was 11.9 years. There was no decrease in eGFR at any postconversion time point as
compared with preconversion. The mean eGFR at time of preconversion was
32.9?mL/min, as compared with 35.6?mL/min at 3 months (p = 0.09), 34.1?mL/min at
6 months (p = 0.63), 34.9?mL/min at 12 months (p = 0.57), and 39.6?mL/min at 24
months after conversion (p = 0.92). Four of 7 patients had increases in their
eGFR after conversion. All grafts were functioning at 1 year after conversion.
CONCLUSION: While this study was limited by a small number of patients,
belatacept conversion stabilized eGFR at all time points in patients with late
allograft function due to chronic tacrolimus toxicity, with a trend towards
increased eGFR at 3 months.