The Successful Use of De Novo Belatacept with Reduced Dose Tacrolimus to Mitigate the Risks of Delayed Graft Function in Kidney Transplantation
American Journal of Transplantation
; 22(Supplement 3):1091, 2022.
Article
in English
| EMBASE | ID: covidwho-2063516
ABSTRACT
Purpose:
The new kidney allocation system has caused increased organ travel times and therefore increased cold ischemia time. Furthermore, the change in the priority to larger transplant centers has caused deprioritized centers to accept higher risk extended criteria donors. These factors lead to increased risk of delayed graft function (DGF). Method(s) To mitigate these risk factors of delayed graft function we have adopted an immunosuppression regimen of de novo belatacept with reduced dose tacrolimus with trough goal level of 5. We hypothesize that the use of belatacept will allow protection against rejection while allowing the renal allogaft to recover from ischemia reperfusion injury without concomitant calcineurin toxicity or vasoconstriction. The delayed addition of low dose tacrolimus can then aid in rejection prevention in addition to belatacept. Result(s) In a cohort of 83 patients we observed one graft loss, two episodes of rejection and three deaths. Of the 130 standard dose tacrolimus with no belatacept we observed no graft losses, seven rejections and one death. Two patients were converted from tacrolimus alone therapy to belatacept plus tacrolimus therapy after the diagnosis of rejection with concomitant tacrolimus toxicity. The belatacept group had a lower rate of rejection, but a higher rate of patient death with a P value <0.001 as calculated with the Z score test. The death in the tacrolimus group was due to covid. Two of the deaths in the belatacept group were cardiovascular, one was a cerebrovascular accident possible related to skull based osteomyelitis. The graft loss in the belatacept group was related to non-compliance. Conclusion(s) Despite initial reports of increased rates of rejection;we report decreased rejection with our belatacept for DGF regimen. We believe this regimen can be a useful tool to utilize more extended criteria donor kidneys in the new kidney allocation system.
adult; adverse drug reaction; cerebrovascular accident; cohort analysis; conference abstract; coronavirus disease 2019; delayed graft function; drug combination; drug therapy; expanded criteria donor; female; graft failure; human; immunosuppressive treatment; kidney transplantation; low drug dose; major clinical study; male; osteomyelitis; reperfusion injury; risk factor; risk reduction; side effect; skull; surgery; vasoconstriction; belatacept; calcineurin; endogenous compound; tacrolimus
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Language:
English
Journal:
American Journal of Transplantation
Year:
2022
Document Type:
Article
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