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2018 ; 18
(7
): 1783-1789
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
De novo donor-specific antibodies in belatacept-treated vs cyclosporine-treated
kidney-transplant recipients: Post hoc analyses of the randomized phase III
BENEFIT and BENEFIT-EXT studies
#MMPMID29509295
Bray RA
; Gebel HM
; Townsend R
; Roberts ME
; Polinsky M
; Yang L
; Meier-Kriesche HU
; Larsen CP
Am J Transplant
2018[Jul]; 18
(7
): 1783-1789
PMID29509295
show ga
Donor-specific antibodies (DSAs) are associated with an increased risk of
antibody-mediated rejection and graft failure. In BENEFIT and BENEFIT-EXT,
kidney-transplant recipients were randomized to receive belatacept more intense
(MI)-based, belatacept less intense (LI)-based, or cyclosporine-based
immunosuppression for up to 7 years (84 months). The presence/absence of
HLA-specific antibodies was determined at baseline, at months 6, 12, 24, 36, 48,
60, and 84, and at the time of clinically suspected episodes of acute rejection,
using solid-phase flow-cytometry screening. Samples from anti-HLA-positive
patients were further tested with a single-antigen bead assay to determine
antibody specificities, presence/absence of DSAs, and mean fluorescence intensity
(MFI) of any DSAs present. In BENEFIT, de novo DSAs developed in 1.4%, 3.5%, and
12.1% of belatacept MI-treated, belatacept LI-treated, and cyclosporine-treated
patients, respectively. The corresponding values in BENEFIT-EXT were 3.8%, 1.1%,
and 11.2%. Per Kaplan-Meier analysis, de novo DSA incidence was significantly
lower in belatacept-treated vs cyclosporine-treated patients over 7 years in both
studies (P < .01). In patients who developed de novo DSAs, belatacept-based
immunosuppression was associated with numerically lower MFI vs cyclosporine-based
immunosuppression. Although derived post hoc, these data suggest that
belatacept-based immunosuppression suppresses de novo DSA development more
effectively than cyclosporine-based immunosuppression.