Effect of an Early Switch to Belatacept Among Calcineurin Inhibitor-Intolerant Graft Recipients of Kidneys From Extended-Criteria Donors.

Transplant recipients receiving a kidney from an extended-criteria donor (ECD) are exposed to calcineurin inhibitor (CNI) nephrotoxicity, as demonstrated by severe delayed graft function and/or a low GFR. Belatacept is a nonnephrotoxic drug that is indicated as an alternative to CNIs. We reported 25 cases of conversion from a CNI to belatacept due to CNI intolerance within the first 6 mo after transplantation. The mean age of the recipients was 59 years, and 24 of 25 patients received ECD kidneys. At the date of the medication switch, 12 of 25 patients displayed a calculated GFR (cGFR) <15 mL/min, six patients remained on dialysis, and the biopsies showed evidence of acute tubular damage associated with severe vascular or tubulointerstitial chronic lesions. Three patients did not recover renal function, and three patients died during the follow-up period. Among the remaining patients, renal function improved: The cGFR was 18.28 ± 12.3 mL/min before the medication switch compared with 34.9 ± 14.5 mL/min at 1 year after conversion to belatacept (p = 0.002). Tolerance of and compliance with belatacept were good, and only one patient experienced acute rejection. Belatacept is an effective therapy that preserves renal function in kidney transplant patients who are intolerant of CNIs.

Renal function of renal transplantation patients after hospitalization in an intensive care unit.

Kidney transplantation is the favored method to treat end-stage renal disease. Some recipients develop severe diseases requiring admission to an intensive care unit (ICU). Acute kidney injury (AKI) is a common complication among critically ill patients but few data are available among renal transplant recipients. The aim of this monocenter retrospective study was to describe renal function in kidney transplant recipients admitted to an ICU and to evaluate their renal functional recovery after this stay. We identified all renal transplant recipients admitted to our medical ICU from January 1, 2001, to December 31, 2010: namely, 79 stays by 62 patients. We used the glomerular filtration rate criteria of the RIFLE classification to evaluate AKI during the ICU stay. During the ICU stay, 56 patients (70.9%) were classified as "no AKI" according to the RIFLE classification; 11 (13.9%) belonged to class R, 10 (12.7%) to class I, and 2 (2.5%) to class F. Overall, 24% of the patients needed dialysis during the ICU stay. Mortality rate at 3 months after the ICU stay was 25.3%. Among the patients who survived, 40 (68%) recovered to their baseline renal function at 3 months, most of them being classified as no AKI during the ICU stay. We have herein reported the evolution of renal function among kidney graft recipients after an ICU stay.