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Tailored use of belatacept in adolescent kidney transplantation.

Authors
  • Blew, Kathryn H1
  • Chua, Annabelle1
  • Foreman, John1
  • Gbadegesin, Rasheed1
  • Jackson, Annette2
  • Nagaraj, Shashi1
  • Sadun, Rebecca1, 3
  • Wigfall, Del1
  • Kirk, Allan D1, 2
  • Chambers, Eileen T1
  • 1 Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
  • 2 Department of Surgery, Duke University Medical Center, Durham, North Carolina.
  • 3 Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Type
Published Article
Journal
American Journal of Transplantation
Publisher
Wiley (Blackwell Publishing)
Publication Date
Sep 24, 2019
Identifiers
DOI: 10.1111/ajt.15611
PMID: 31550421
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Adolescent transplant recipients are at risk for nonadherence, development of de novo donor-specific antibody (dnDSA), and allograft loss. Belatacept, a selective T cell costimulatory blocker, is associated with reduced dnDSA, improved renal function, and prolonged allograft survival when compared to calcineurin inhibitor-based regimens in adults; however, its use in children is scant. Three adolescents were initiated on belatacept between August 2017 and September 2018 at the time of kidney transplantation. Selection criteria included age ≥ 14 and EBV IgG + serostatus. Intraoperative alemtuzumab and methylprednisolone were given as induction therapy. Tailored maintenance therapy included steroid-free belatacept and sirolimus for two patients. One patient was initially maintained steroid-free on belatacept and belimumab, an inhibitor of B cell activating factor to treat concurrent systemic lupus erythematous; steroids were added subsequently. Renal function, biopsy-proven rejection, dnDSA, allograft survival, infection, nonadherence, and proteinuria were monitored. Renal function was 86, 73, 52 mL/min/1.73 m2 at 20, 20, and 8 months, respectively. There was 100% adherence to therapy and no development of dnDSA. All patients had treatable infections. One developed steroid-responsive acute cellular rejection. Belatacept-based regimens can be tailored for adolescent recipients with good short-term clinical outcomes. © 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.

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