AUTHOR=Bertrand Dominique , Chavarot Nathalie , Olagne Jérôme , Greze Clarisse , Gatault Philippe , Danthu Clément , Colosio Charlotte , Jaureguy Maïté , Duveau Agnès , Bouvier Nicolas , Le Meur Yannick , Golbin Léonard , Thervet Eric , Thierry Antoine , François Arnaud , Laurent Charlotte , Lemoine Mathilde , Anglicheau Dany , Guerrot Dominique 

TITLE=Biopsy-Proven T-Cell Mediated Rejection After Belatacept Rescue Conversion: A Multicenter Retrospective Study

JOURNAL=Transplant International

VOLUME=Volume 37 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.13544

DOI=10.3389/ti.2024.13544

ISSN=1432-2277

ABSTRACT=After kidney transplantation, conversion to belatacept is a promising alternative in patients with low graft function or intolerance to calcineurin inhibitors. The risk of acute rejection has not been well described in these conditions. Here we present a retrospective multicenter study investigating the occurrence of acute rejection after conversion in 901 patients (2011-2021). The incidence of cellular and humoral rejection was 5.2% and 0.9%, respectively. T cell mediated rejection (TCMR) occurred after a median of 2.6 months after conversion. Among 47 patients with TCMR, death censored graft survival was 70.1%, 55.1% and 50.8% at 1 year, 3 years and 5 years post rejection respectively. Eight patients died after rejection, mainly of infectious disease. We compared these 47 patients with a cohort of kidney transplant recipients converted to belatacept between 2011 and 2017 who did not develop rejection (n=238). In multivariate analysis, shorter time between KT and conversion, and the absence of anti-thymocyte globulins induction after KT were associated with the occurrence of TCMR after belatacept conversion. The occurrence of rejection after conversion to belatacept appears to be less frequent than with de novo use. Nevertheless, the risk of graft loss could be significant in patients with already low renal function.