Belatacept as a CNI-sparing immunosuppression strategy following lung transplantation

Results from a multi-institutional retrospective study, evaluating conversion to belatacept, a co-stimulation blocker, as a calcineurin inhibitor (CNI)-sparing therapy in adult lung transplant recipients, were published in Transplant Immunology by Younis et al. The analysis compared patients who received belatacept (n = 170) with contemporaneous controls (n = 288). The primary outcome was change in estimated glomerular filtration rate (eGFR) following belatacept initiation.

Key data: In the belatacept group, median eGFR was 43 mL/min/1.73 m² at initiation, 46 mL/min/1.73 m² at 6 months, and 43 mL/min/1.73 m² at 1 year following belatacept initiation, with an overall change of 0 mL/min/1.73 m² (interquartile range [IQR], −21 to 52; p = 0.21). Median eGFR in the control group declined from 60 mL/min/1.73 m² at transplant to 57 mL/min/1.73 m² at 6 months and 48 mL/min/1.73 m² at 1 year, with an overall change of −18 mL/min/1.73 m² (IQR, −30 to −5; p < 0.0001). There were no significant differences between groups in rates of chronic lung allograft dysfunction (CLAD), acute cellular rejection, antibody-mediated rejection, de novo donor-specific antibodies, forced expiratory volume in 1 second, infections, or malignancy.

Key learning: Belatacept-based immunosuppression was associated with stabilization of renal function without increased rates of rejection, CLAD, or malignancy, supporting consideration of belatacept as a CNI-sparing strategy in lung transplant recipients.