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Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients

INTRODUCTION: During the coronavirus disease 2019 (Covid-19) pandemic, several physicians have questioned pursuing belatacept in kidney-transplant patients in order to reduce the risk of nosocomial transmission during the monthly infusion. The effect of the conversion from belatacept to another immu...

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Autores principales: Gouin, Anna, Sberro-Soussan, Rebecca, Courivaud, Cécile, Bertrand, Dominique, Del Bello, Arnaud, Darres, Amandine, Ducloux, Didier, Legendre, Christophe, Kamar, Nassim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710888/
https://www.ncbi.nlm.nih.gov/pubmed/33305112
http://dx.doi.org/10.1016/j.ekir.2020.09.036
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author Gouin, Anna
Sberro-Soussan, Rebecca
Courivaud, Cécile
Bertrand, Dominique
Del Bello, Arnaud
Darres, Amandine
Ducloux, Didier
Legendre, Christophe
Kamar, Nassim
author_facet Gouin, Anna
Sberro-Soussan, Rebecca
Courivaud, Cécile
Bertrand, Dominique
Del Bello, Arnaud
Darres, Amandine
Ducloux, Didier
Legendre, Christophe
Kamar, Nassim
author_sort Gouin, Anna
collection PubMed
description INTRODUCTION: During the coronavirus disease 2019 (Covid-19) pandemic, several physicians have questioned pursuing belatacept in kidney-transplant patients in order to reduce the risk of nosocomial transmission during the monthly infusion. The effect of the conversion from belatacept to another immunosuppressive regimen is underreported. The aim of the present retrospective study was to assess the effect on kidney function and the clinical outcome of the conversion from belatacept to another regimen. METHODS: We have identified 44 maintenance kidney transplantation patients from five French kidney transplantation centers who were converted from belatacept to another regimen either because of a complication (n = 28) or another reason (patients’ request or belatacept shortage, n = 13). The follow-up after the conversion from belatacept was 27.5 ± 25.3 months. RESULTS: Overall, mean estimated glomerular filtration rate (eGFR) decreased from 44.2 ± 16 ml/min per 1.73 m(2) at conversion from belatacept to 35.7 ± 18.4 ml/min per 1.73 m(2) at last follow-up (P = 0.0002). eGFR significantly decreased in patients who had been given belatacept at transplantation as well as in those who had been converted to belatacept earlier. The decrease was less significant in patients who had stopped belatacept without having experienced any complications. Finally, eGFR decreased more severely in patients who were converted to calcineurin inhibitors (CNIs), compared to those who received mammalian target of rapamycin inhibitor (mTORi). Few patients also developed diabetes and hypertension. CONCLUSIONS: Thus, transplantation physicians should avoid stopping belatacept when not clinically required.
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spelling pubmed-77108882020-12-09 Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients Gouin, Anna Sberro-Soussan, Rebecca Courivaud, Cécile Bertrand, Dominique Del Bello, Arnaud Darres, Amandine Ducloux, Didier Legendre, Christophe Kamar, Nassim Kidney Int Rep Clinical Research INTRODUCTION: During the coronavirus disease 2019 (Covid-19) pandemic, several physicians have questioned pursuing belatacept in kidney-transplant patients in order to reduce the risk of nosocomial transmission during the monthly infusion. The effect of the conversion from belatacept to another immunosuppressive regimen is underreported. The aim of the present retrospective study was to assess the effect on kidney function and the clinical outcome of the conversion from belatacept to another regimen. METHODS: We have identified 44 maintenance kidney transplantation patients from five French kidney transplantation centers who were converted from belatacept to another regimen either because of a complication (n = 28) or another reason (patients’ request or belatacept shortage, n = 13). The follow-up after the conversion from belatacept was 27.5 ± 25.3 months. RESULTS: Overall, mean estimated glomerular filtration rate (eGFR) decreased from 44.2 ± 16 ml/min per 1.73 m(2) at conversion from belatacept to 35.7 ± 18.4 ml/min per 1.73 m(2) at last follow-up (P = 0.0002). eGFR significantly decreased in patients who had been given belatacept at transplantation as well as in those who had been converted to belatacept earlier. The decrease was less significant in patients who had stopped belatacept without having experienced any complications. Finally, eGFR decreased more severely in patients who were converted to calcineurin inhibitors (CNIs), compared to those who received mammalian target of rapamycin inhibitor (mTORi). Few patients also developed diabetes and hypertension. CONCLUSIONS: Thus, transplantation physicians should avoid stopping belatacept when not clinically required. Elsevier 2020-10-06 /pmc/articles/PMC7710888/ /pubmed/33305112 http://dx.doi.org/10.1016/j.ekir.2020.09.036 Text en © 2020 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Gouin, Anna
Sberro-Soussan, Rebecca
Courivaud, Cécile
Bertrand, Dominique
Del Bello, Arnaud
Darres, Amandine
Ducloux, Didier
Legendre, Christophe
Kamar, Nassim
Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients
title Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients
title_full Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients
title_fullStr Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients
title_full_unstemmed Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients
title_short Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients
title_sort conversion from belatacept to another immunosuppressive regimen in maintenance kidney-transplantation patients
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710888/
https://www.ncbi.nlm.nih.gov/pubmed/33305112
http://dx.doi.org/10.1016/j.ekir.2020.09.036
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