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Article Dans Une Revue PLoS ONE Année : 2023

Conversion to belatacept after lung transplantation: Report of 10 cases

Olivier Brugière
Alexandre Vallée
  • Fonction : Auteur
Quentin Raimbourg
  • Fonction : Auteur
Marie-Noelle Peraldi
  • Fonction : Auteur
Sylvie Colin de Verdière
  • Fonction : Auteur
Laurence Beaumont
  • Fonction : Auteur
Abdulmonem Hamid
  • Fonction : Auteur
Mathilde Zrounba
  • Fonction : Auteur
Clément Picard
  • Fonction : Auteur
François Parquin
  • Fonction : Auteur
Matthieu Glorion
  • Fonction : Auteur
Julie Oniszczuk
  • Fonction : Auteur
Alexandre Hertig
  • Fonction : Auteur
Hervé Mal
  • Fonction : Auteur
Vincent Bunel

Résumé

Background Calcineurin inhibitors (CNIs) remain the cornerstone of maintenance immunosuppression (IS) after lung transplantation (LTx), although CNI-related life-threatening toxic effects may occur. Belatacept, a novel immunosuppressant that blocks a T-cell co-stimulation pathway, is a non-nephrotoxic drug indicated as an alternative to CNIs in kidney Tx. In LTx, there are only a few reports of belatacept conversion as a CNI-free or CNI-sparing IS treatment. Methods We reviewed a series of 10 LTx recipients with conversion to a CNI-free belatacept IS regimen within the first year post-LTx (n = 7) or a belatacept/low-dose CNI combination after the first year (n = 3). Results Use of belatacept was triggered by severe renal failure in 9 patients and under-IS with previous other IS-related toxicities in 1 patient. Mean estimated glomerular filtration rate after starting belatacept significantly improved at 6 months after initiation and at the last-follow-up (p = 0.006, and p = 0.002 respectively). The incidence of recurrent and/or severe acute cellular rejection (ACR) episodes was high in patients with CNI-free belatacept-based IS (n = 4/7). Chronic graft allograft dysfunction developed in 2 of 9 recipients under belatacept IS. Belatacept was stopped in 6 patients because of recurrent/severe ACR (n = 3), recurrent opportunistic infections (n = 1), center modified policy (n = 1), or other cause (n = 1). Conclusion Early conversion to CNI-free belatacept-based IS improved renal function in this series but was counterbalanced by a high incidence of recurrent ACR, including life-threatening episodes. Other studies are needed to better determine the indications for its use after LTx, possibly with lower immunological risk IS regimens, such as CNI-sparing belatacept.

Dates et versions

hal-04481963 , version 1 (28-02-2024)

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Citer

Olivier Brugière, Alexandre Vallée, Quentin Raimbourg, Marie-Noelle Peraldi, Sylvie Colin de Verdière, et al.. Conversion to belatacept after lung transplantation: Report of 10 cases. PLoS ONE, 2023, 18 (3), pp.e0281492. ⟨10.1371/journal.pone.0281492⟩. ⟨hal-04481963⟩
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