Abstract
Lung transplantation (LT) relies heavily on calcineurin inhibitors for the prevention of rejection but they can lead to chronic kidney dysfunction. The use of belatacept has been reported to stabilize renal function in some cases and small series of LT recipients (LTRs). We aimed to describe our experience using belatacept as a pharmacological strategy to preserve renal function without allograft dysfunction in a larger cohort of LTRs.
After IRB approval, we queried our institutional database for clinical data and outcomes from LTRs who received at least 1 dose of belatacept between September 2019 and August 2022. Patients were followed clinically and with laboratory tests at 1 month after belatacept initiation, every 3 months during the first year, and then every 6 months. Analyzed outcomes included changes in renal and lung function.
Thirty-seven LTRs were included; median age was 67 years (IQR 63-70). Indications for LT were restrictive lung disease (n=16; 43.2%) and obstructive lung disease (n=14; 37.8%). The indications for belatacept were renal sparing (n=35) and thrombotic microangiopathies (n=2). The median time to the initiation of belatacept was 166 days (IQR 166-824) after LT. Before belatacept initiation, 6 months after, and 12 months after, the median serum creatinine (mg/dL)/glomerular filtration (ml/min/1.73 m2) levels were 2.11/29, 1.9/34, and 2.21/33, respectively. Graft function remains, with a median FEV1 of 2.05L at 1 month, 2.12L at 6 months, and 2.03L at 12 months. There were no acute cellular rejections episodes within a year of starting belatacept.
The serum creatine concentration stabilized without graft dysfunction in most patients after belatacept initiation. Our ongoing analyses include the identification of leukopenia, infections, and de novo neoplasms in the same cohort; our data suggest that leukopenia is the most frequent side effect necessitating medication changes with valganciclovir and mycophenolic acid.