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Optimization of de novo belatacept-based immunosuppression administered to renal transplant recipients.

Publication ,  Journal Article
Kirk, AD; Adams, AB; Durrbach, A; Ford, ML; Hildeman, DA; Larsen, CP; Vincenti, F; Wojciechowski, D; Woodle, ES
Published in: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
May 2021

Kidney transplant recipients administered belatacept-based maintenance immunosuppression present with a more favorable metabolic profile, reduced incidence of de novo donor-specific antibodies (DSAs), and improved renal function and long-term patient/graft survival relative to individuals receiving calcineurin inhibitor (CNI)-based immunosuppression. However, the rates and severity of acute rejection (AR) are greater with the approved belatacept-based regimen than with CNI-based immunosuppression. Although these early co-stimulation blockade-resistant rejections are typically steroid sensitive, the higher rate of cellular AR has led many transplant centers to adopt immunosuppressive regimens that differ from the approved label. This article summarizes the available data on these alternative de novo belatacept-based maintenance regimens. Steroid-sparing, belatacept-based immunosuppression (following T cell-depleting induction therapy) has been shown to yield AR rates comparable to those seen with CNI-based regimens. Concomitant treatment with belatacept plus a mammalian target of rapamycin inhibitor (mTORi; sirolimus or everolimus) has yielded AR rates ranging from 0 to 4%. Because the optimal induction agent and number of induction doses; blood levels of mTORi; and dose, duration, and use of corticosteroids have yet to be determined, larger prospective clinical trials are needed to establish the optimal alternative belatacept-based regimen for minimizing early cellular AR occurrence.

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Published In

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

DOI

EISSN

1600-6143

ISSN

1600-6135

Publication Date

May 2021

Volume

21

Issue

5

Start / End Page

1691 / 1698

Related Subject Headings

  • Transplant Recipients
  • Surgery
  • Prospective Studies
  • Kidney Transplantation
  • Immunosuppressive Agents
  • Immunosuppression Therapy
  • Humans
  • Graft Survival
  • Graft Rejection
  • Calcineurin Inhibitors
 

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Kirk, A. D., Adams, A. B., Durrbach, A., Ford, M. L., Hildeman, D. A., Larsen, C. P., … Woodle, E. S. (2021). Optimization of de novo belatacept-based immunosuppression administered to renal transplant recipients. American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 21(5), 1691–1698. https://doi.org/10.1111/ajt.16386
Kirk, Allan D., Andrew B. Adams, Antoine Durrbach, Mandy L. Ford, David A. Hildeman, Christian P. Larsen, Flavio Vincenti, David Wojciechowski, and E Steve Woodle. “Optimization of de novo belatacept-based immunosuppression administered to renal transplant recipients.American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons 21, no. 5 (May 2021): 1691–98. https://doi.org/10.1111/ajt.16386.
Kirk AD, Adams AB, Durrbach A, Ford ML, Hildeman DA, Larsen CP, et al. Optimization of de novo belatacept-based immunosuppression administered to renal transplant recipients. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2021 May;21(5):1691–8.
Kirk, Allan D., et al. “Optimization of de novo belatacept-based immunosuppression administered to renal transplant recipients.American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 21, no. 5, May 2021, pp. 1691–98. Epmc, doi:10.1111/ajt.16386.
Kirk AD, Adams AB, Durrbach A, Ford ML, Hildeman DA, Larsen CP, Vincenti F, Wojciechowski D, Woodle ES. Optimization of de novo belatacept-based immunosuppression administered to renal transplant recipients. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2021 May;21(5):1691–1698.
Journal cover image

Published In

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

DOI

EISSN

1600-6143

ISSN

1600-6135

Publication Date

May 2021

Volume

21

Issue

5

Start / End Page

1691 / 1698

Related Subject Headings

  • Transplant Recipients
  • Surgery
  • Prospective Studies
  • Kidney Transplantation
  • Immunosuppressive Agents
  • Immunosuppression Therapy
  • Humans
  • Graft Survival
  • Graft Rejection
  • Calcineurin Inhibitors