Switch from calcineurin inhibitors to belatacept in kidney transplant patients with chronic-active antibody mediated rejection results in lower decline in kidney function at three years

2021 ◽  
Author(s):  
Tristan de Nattes ◽  
Arnaud François ◽  
Sophie Candon ◽  
Isabelle Etienne ◽  
Charlotte Laurent ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Kidney Function ◽  
Calcineurin Inhibitors ◽  
Antibody Mediated Rejection ◽  
Transplant Patients ◽  
Kidney Transplant Patients

scholarly journals Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1327
Author(s):  
Ruta Vaiciuniene ◽  
Brigita Sitkauskiene ◽  
Inga Arune Bumblyte ◽  
Egle Dalinkeviciene ◽  
Edita Ziginskiene ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Antibody Response ◽  
Kidney Transplant ◽  
Kidney Function ◽  
Hemoglobin Level ◽  
Total Leucocyte Count ◽  
Binary Logistic Regression Analysis ◽  
Cd8 Cells ◽  
Transplant Patients ◽  
Kidney Transplant Patients

Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman’s correlation coefficient −0.4, p = 0.02), percentage of CD19+ cells (r = −0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.

scholarly journals P1756ANTI-ABO ANTIBODY- VERSUS ANTI-HLA ANTIBODY-INDUCED ANTIBODY MEDIATED REJECTION IN ABO-INCOMPATIBLE KIDNEY TRANSPLANT PATIENTS: RELATIVE INCIDENCE AND PHENOTYPE DIFFERENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jinmin Kong ◽  
Hyukyong Kwon ◽  
Sung Son ◽  
EUN Whang
Keyword(s):  
Kidney Transplant ◽  
Blood Group ◽  
Relative Frequency ◽  
Response To Treatment ◽  
Clinical Feature ◽  
Antibody Mediated Rejection ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Hla Antibody ◽  
Case Based

Abstract Background and Aims Antibody-mediated rejection(AMR) in ABO incompatible(ABOi) kidney transplant(KT) patients can either be due to donor-specific anti-HLA antibody(DSA) or anti-blood group antibody. The relative frequency and possible phenotype difference of these two types of AMR in ABOi KT patients have not been reported. Method Of 111 ABOi KT patients between 2007 and 2019 in our center, 15(13.5%) patients developed acute AMR diagnosed by indication biopsy. Since there is no histologic distinction between DSA- and anti-ABO-induced AMR, we assumed the causative antibody in each case based on anti-ABO level and DSA, measured in serum collected at the time of AMR. Results Of these 15 cases of acute AMR, 5 were attributable to anti-ABO(ABO-AMR) since anti-ABO titer was higher (≥16) and DSA was undetectable at the time of rejection. Five cases were attributable to DSA(DSA-AMR) since DSA was detectable and anti-ABO was lower during rejection. Another 3 cases with lower anti-ABO titer and undetectable DSA were also assumed to be DSA-induced, since this low level of anti-ABO is unlikely to cause rejection and DSA can be undetectable in DSA-induced AMR by adsorption of Ab on graft, as frequently seen in ABO-compatible patients Two cases with both higher anti-ABO titer and detectable DSA was regarded as undetermined. The onset of acute AMR was within 2 weeks in all cases(median 7.0 days) and comparable between DSA- and ABO-AMR. Initial anti-ABO titer was also not statistically different; median(range) 256(64-4096) in ABO-AMR and 64(16-256) in DSA-AMR. All the 5 patients with ABO-AMR had negative PRA before KT, whereas 5 of 8 patients with DSA-AMR had positive PRA before KT, and two DSA-AMR patients had preformed DSA before KT. There was no difference in peak creatinine and response to treatment. All the AMR were recovered by treatment and no graft was lost to rejection. No patient with ABO-AMR developed chronic AMR whereas one of DSA-AMR patients developed chronic AMR. Conclusion In summary, among 15 cases of acute AMR, 5 were ABO-AMR, 8 were DSA-AMR and 2 were undetermined. There was no difference in clinical feature between DSA- and ABO-AMR. No patient with ABO-AMR developed chronic AMR.

Long-term Results of Conversion From Calcineurin Inhibitors to Sirolimus in 150 Maintenance Kidney Transplant Patients

2012 ◽  
Vol 10 (2) ◽  
pp. 110-118 ◽  
Author(s):  
Cyril Garrouste ◽  
Nassim Kamar ◽  
Céline Guilbeau-Frugier ◽  
Joëlle Guitard ◽  
Laure Esposito ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Calcineurin Inhibitors ◽  
Long Term Results ◽  
Transplant Patients ◽  
Kidney Transplant Patients

scholarly journals Beneficial Effect of Conversion to Belatacept in Kidney-Transplant Patients with a Low Glomerular-Filtration Rate

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Julie Belliere ◽  
Céline Guilbeau-Frugier ◽  
Arnaud Del Bello ◽  
Laure Esposito ◽  
Caroline Capuani ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Kidney Transplant ◽  
Kidney Function ◽  
Filtration Rate ◽  
Case Reports ◽  
Rescue Therapy ◽  
Mtor Inhibitors ◽  
Transplant Patients ◽  
Kidney Transplant Patients

Belatacept has been found to be efficient at preserving good kidney function in maintenance kidney-transplant patients. Herein, we report on the use of belatacept as a rescue therapy for two kidney-transplant patients presenting with severe adverse events after treatment with calcineurin inhibitors (CNIs) and mammalian target-of-rapamycin (mTOR) inhibitors. Two kidney-transplant patients developed severely impaired kidney function after receiving CNIs. The use of everolimus was associated with severe angioedema. Belatacept was then successfully used to improve kidney function in both cases, even though estimated glomerular-filtration rate before conversion was <20 mL/min. These case reports show that belatacept can be used as a rescue therapy, even if kidney function is very low in kidney-transplant patients who cannot tolerate CNIs and/or mTOR inhibitors.

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