ESPN 54th Annual Meeting

ESPN 2022


 
Belatacept outcomes in pediatric kidney transplantation: The Robert Debre experience
CHARLOTTE DUNETON 1 ELODIE CHEYSSAC 1 HOUAIDA DAHDOUH 1 VERONIQUE BAUDOUIN 1 HOGAN JULIEN 1

1- PEDIATRIC NEPHROLOGY DEPARTMENT, ROBERT DEBRé HOSPITAL, APHP, PARIS FRANCE
 
Introduction:

Belatacept is associated with reduced dnDSA, improved renal function, and prolonged allograft survival in adult transplant recipients. Its use in older children and young adults is limited. We report outcomes for 13 pediatric patients converted to belatacept.

Material and methods:

13 patients were converted to belatacept between 2018 and 2021 in Robert Debré Hospital. Patients received an induction with basiliximab (n=8) or ATG (n=5). Maintenance immunosuppression included CNI, antimetabolite and steroids. Patients’ viral status were monitored monthly and allograft biopsy was performed prior to conversion and 6 months after conversion. The first 5 belatacept injections were administered at 5mg/kg/dose every 2 weeks, then monthly. CNI doses were decreased by 25% at each infusion and stopped after 2 months. Antimetabolite doses were also increased at CNI withdrawal. 6/13 patients were steroid-free at the time of conversion.

Results:

Median age at conversion was 17,6 years (range 10,3-19,4) and 3,9 years (IQR 1,3 – 6) post-transplant. Conversion indication was based on medical need for long term CNI avoidance (n=11) or to improve adherence (n=2). CNI was withdrawn in all patients after a median of 42 days (IQR 42-75). GFR was stable or improved over a median follow-up time of 12,1 months (IQR 9,6-20,3). Rejection episodes were observed in 4/13 patients (median 10,3 months, IQR 7,3-19,1): 2 chronic active TCMR IA, 1 mixed acute rejection (TCMR IB and ABMR) and 1 ABMR (both DSA-negative). 2 had prior history of rejection (with normal pre-belatacept biopsies), 1 showed minimal interstitial inflammation without tubulitis (and was off steroids) prior to starting belatacept and 1 had been converted for adherence problems, which subsequently persisted. Rejection episodes showed good evolution after treatment, but CNI were reintroduced for 2/4. No severe viral complications or development of dnDSA were observed.

Conclusions:

Selected pediatric kidney recipients may benefit from long-term CNI toxicity avoidance, but selection criteria need to be refined.