1. Opportunistic Infections and Efficacy Following Conversion to Belatacept-Based Therapy after Kidney Transplantation: A French Multicenter Cohort
- Author
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Rebecca Sberro, Antoine Thierry, Johan Noble, Anne Grall-Jezequel, Paolo Malvezzi, Johnny Sayegh, Nicolas Bouvier, Sophie Caillard, Florian Terrec, Maïté Jauréguy, Cyril Garrouste, Leonard Golbin, Eric Thervet, Thomas Jouve, Lionel Rostaing, Jean-Philippe Rerolle, Nathalie Chavarot, Philippe Gatault, Charlotte Colosio, Bénédicte Janbon, Dominique Bertrand, and Isabelle Etienne
- Subjects
medicine.medical_specialty ,030232 urology & nephrology ,Renal function ,kidney transplantation ,lcsh:Medicine ,030230 surgery ,Pneumocystis pneumonia ,Belatacept ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cumulative incidence ,tacrolimus ,Kidney transplantation ,belatacept ,business.industry ,Incidence (epidemiology) ,pneumocystis pneumonia ,lcsh:R ,General Medicine ,opportunistic infections ,medicine.disease ,Cohort ,business ,CMV infection ,medicine.drug ,Cohort study - Abstract
Conversion from calcineurin-inhibitors (CNIs) to belatacept can help kidney-transplant (KT) recipients avoid CNI-related nephrotoxicity. The risk of associated opportunistic infections (OPIs) is ill-defined. We conducted a multicentric cohort study across 15 French KT-centers in a real-life setting. Between 07-2010 and 07-2019, 453 KT recipients were converted from CNI- to belatacept-based therapy at 19 [0.13&ndash, 431] months post-transplantation. Most patients, i.e., 332 (79.3%), were converted after 6-months post-transplantation. Follow-up time after conversion was 20.1 +/&minus, 13 months. OPIs developed in 42(9.3%) patients after 14 +/&minus, 12 months post-conversion. Eight patients (19%) had two OPI episodes during follow-up. Incidences of CMV DNAemia and CMV disease were significantly higher in patients converted before 6-months post-KT compared to those converted later (i.e., 31.6% vs. 11.5%, p <, 0.001, and 11.6% vs. 2.4%, p <, 0.001, respectively). Cumulative incidence of OPIs was 6.5 OPIs/100 person&ndash, years. Incidence of CMV disease was 2.8/100 person&ndash, years, of pneumocystis pneumonia 1.6/100 person&ndash, years, and of aspergillosis 0.2/100 person&ndash, years. Multivariate analyses showed that estimated glomerular filtration (eGFR) <, 25 mL/min/1.73 m2 at conversion was independently associated with OPIs (HR = 4.7 (2.2 &minus, 10.3), p <, 0.001). The incidence of EBV DNAemia was 17.3 events /100 person&ndash, years. At 1-year post-conversion, mean eGFR had significantly increased from 32.0 +/&minus, 18 mL/min/1.73 m2 to 42.2 +/&minus, 18 mL/min/1.73 m2 (p <, 0.0001). Conversion to belatacept is an effective strategy with a low infectious risk.
- Published
- 2020