Belatacept in kidney transplant patients with systemic lupus erythematosus

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• dc.contributor.author Carrión-Barberà, María Irene
• dc.contributor.author Fajardo, Melissa
• dc.contributor.author Danias, George
• dc.contributor.author Tsapepas, Demetra
• dc.contributor.author Gartshteyn, Yevgeniya
• dc.contributor.author Fernández, Hilda
• dc.contributor.author Askanase, Anca
• dc.date.accessioned 2021-04-06T06:43:07Z
• dc.date.available 2021-04-06T06:43:07Z
• dc.date.issued 2019
• dc.description.abstract Objectives: Lupus nephritis (LN) requires renal replacement therapy in 10%-30% of patients. About 30% of these patients receive a kidney transplant. Belatacept is a second-generation, selective, T-cell co-stimulator blocker (inhibits cytotoxic, T-lymphocyte antigen 4, CTLA-4) used as an alternative to calcineurin inhibitors (CNI) for maintenance regimens after kidney transplantation. The pathogenic relevance of CTLA-4 inhibition and the favourable cardiovascular profile of belatacept make it an attractive therapeutic option in systemic lupus erythematosus (SLE). Intravenous administration of belatacept ensures therapeutic adherence. Methods: This retrospective, single-centre study evaluates the outcomes of LN kidney transplant recipients treated with belatacept for reasons not related to SLE at the Columbia University Lupus and Renal Transplant Cohort. Results: Belatacept was started in six patients on CNI regimens at 15.5±17.1 months following transplantation for LN. In five patients, creatinine levels stabilised 6 months after belatacept, one returned to haemodialysis due to CNI toxicity and pyelonephritis and one relisted for a kidney transplant following acute cellular rejection and cortical necrosis. Five patients are followed for extrarenal lupus; no extrarenal manifestations were documented in the other two patients. Data on SLE disease activity pre-belatacept and post-belatacept were available and scored in three patients using the SLE Disease Activity Index Glucocorticosteroid Index (SLEDAI-2KG), which accounts for clinical and laboratory manifestations, as well as steroid dose. Mean SLEDAI-2KG decreased from 13 to 7.6. Conclusion: Belatacept in LN kidney transplant recipients may decrease extrarenal manifestations, attenuate CNI toxicity and stabilise allograft function, providing a better alternative to CNI regimens. Furthermore, these data suggest that belatacept, although initiated for reasons not related to SLE, might have a beneficial effect in SLE.
• dc.format.mimetype application/pdf
• dc.identifier.citation Carrión-Barberà I, Fajardo M, Danias G, Tsapepas D, Gartshteyn Y, Fernandez H, et al. Belatacept in kidney transplant patients with systemic lupus erythematosus. Lupus Sci Med. 2019 Dec 22; 6(1): e000355. DOI: 10.1136/lupus-2019-000355
• dc.identifier.doi http://dx.doi.org/10.1136/lupus-2019-000355
• dc.identifier.issn 2053-8790
• dc.identifier.uri http://hdl.handle.net/10230/47018
• dc.language.iso eng
• dc.publisher BMJ Publishing Group
• dc.rights Copyright © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
• dc.subject.keyword Treatment
• dc.subject.keyword Autoimmune diseases
• dc.subject.keyword Lupus nephritis
• dc.subject.keyword Systemic lupus erythematosus
• dc.title Belatacept in kidney transplant patients with systemic lupus erythematosus
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion