Protective Effects of Converting to Belatacept Following Kidney Transplant

American Transplant Congress 2021

Calcineurin inhibitors (CNI) have adverse effects on cardiovascular risk among kidney transplant recipients. Conversion to belatacept may reduce the cardiovascular risk in that patient population. H. Mogallapalli conducted a study to test the hypothesis that early conversion to belatacept would result in improved patient and graft survival and lower rates of readmission within 30 days in kidney transplant recipients with congestive heart failure compared with long-term use of CNI.

Results of the study were reported during a virtual session at the 2021 American Transplant Congress. The presentation was titled Association of Belatacept Conversion on Patient and Allograft Survival in Kidney Transplant Recipients with Congestive Heart Failure.

The study utilized the Wisconsin Allograft Recipient Database to merge data on belatacept with the Clarity Healthline dataset that contains data on kidney transplant recipients admitted with congestive heart failure between 2014 and 2019. The International Classification of Diseases, Tenth Revision code I50 was used to identify patients with congestive heart failure and code E87.70 was used to identify patients with volume overload.

Study participants who switched to belatacept were categorized into early conversion (EC, defined as switched to belatacept within 1 year of transplant) and late conversion (LC, defined as switched later than 1 year after transplant). Greedy matching was used for the EC and the LC participants based on transplant date in a 1:2 allocation ratio to CNI controls (control).

The total study cohort included 301 patients. Of those, 31.5% (n=97) were in the EC group, 25.1% (n=77) were in the LC group, and 43.3% (n=133) were in the control group. Median patient survival was 2 years in the control group, 2.2 years in the EC group, and 3.4 years in the LC group (P<.001). There were no significant differences among the groups in the prevalence of history of myocardial infarction, congestive heart failure, and coronary artery disease at the time of transplant.

Mean time to switching to belatacept was 3.36 months in the EC group and 3.5 years in the LC group. Compared with the two belatacept groups, participants in the control group had significantly higher rate of basiliximab induction (P=.001), were more likely to have received a deceased donor transplant (P=.05), and had significantly younger donor age (43.2 years; P=.04).

Results of adjusted hazard models demonstrated no statistical difference in patient survival among the three groups. There was an association between belatacept and better numerical patient and graft survival (adjusted hazard ratio [aHR], 0.36; 95% confidence interval [CI], .03-3.8; P=.4 and aHR, 0.74; 95% CI, 0.1-7.2; P=.8, respectively). There was no significant difference among the groups in the rate of readmission within 30 days (18%, 11%, and 15% in controls, EC, and LC, respectively; P=.32).

In summary, the researchers said, “Patient and graft survival and rate of admission within 30 days post congestive heart failure hospital discharge were not significantly different among the three groups. However, the patient and graft survival rates do suggest clinically protective effects of converting patients to belatacept after transplant date.”

Source: Mogallapalli H. Association of belatacept conversion in patients and allograft survival in kidney transplant recipients with congestive heart failure. Abstract of a presentation at the virtual American Transplant Congress 2021 (abstract #938), June 6, 2021.