Initial experience with Belatacept in Pancreas Transplantation

UVA, PABLO D.; QUEVEDO ALEJANDRA; ROSES JOSEFINA; PILOTTI ROXANA; TONIOLO FERNANDA; CHULUYAN, EDUARDO; CASADEI, DOMINGO

Lyon

Congreso; World Congress of the International Pancreas and Islet Association (IPITA); 2019

IPITA

In pancreas transplantation rejection is a major cause of late graft survival, however drug toxicity often impairs both kidney andpancreas function. Belatacept may play a role in decreasing this toxicity but experience in pancreas transplantation is scarce. Wepresent our experience with Belatacept in pancreas transplantation.Purpose: To review our experience with Belatacept in pancreas transplantation.Materials and methods: Retrospective review including all patients receiving Belatacept after pancreas transplantation. Main objectiveis to review rejection rate, de novo anti-HLA antibodies, infection rate and pancreas and patient survival.Results: 27 patients (EBV+) received Belatacept (2 de novo and 25 conversions) due to CNI toxicity (11), severe kidney dysfunctionwith chronic histological damage (5), pancreas dysfunction (3), AMR with anti-HLA Ab (6), high cardiovascular risk (1) and a partialpancreas (1). Tacrolimus was minimized in 11 cases and discontinued in 16. With a mean f/u of 2.1 years (0.4-3.5y), there were 3rejection episodes (1Kid, 1Pan, 1KP) at 7, 11 and 27 mo. Two of them had history of previous rejection episodes. Only 2/14 patientswith initially negative antibodies developed de novo DSA (1) or non DSA (1) antibodies (both were CNI free) and 3/13 patients withpositive antibodies became negative after Belatacept use. The group of patients severe with kidney dysfunction (creatinine above 2.5),was started on Belatacept with tacrolimus discontinuation to delay the progression to kidney failure. In this group mean time to dialysiswas 21 mo (13-30mo). There was 1 case of CMV infection, no cases of BKV viremia and 1 case of histoplasma disease after treatmentfor rejection with steroid pulses and Thymoglobulin. This was the only case of mortality. There were no immunological pancreas graftlosses.DiscussionIn selected cases Belatacept may play a role in pancreas immunosuppression.