COMPARISON OF LONG-TERM OUTCOMES AFTER CONVERSION TO BELATACEPT WITH EITHER TACROLIMUS (TAC) OR MYCOPHENOLATE (MMF) AND PREDNISONE

Purpose: To study the efficacy and side effects of converting to Belatacept-Based (Bela) therapy in recipients of kidney transplant (KT). Methods: we studied patient transplanted between 5/2011 and 8/2019. 39 patients were converted to Bela-Based therapy. Of these 39 patients only 16 completed 2 years of observation and were included in this study. Patients were stratified by two groups. Group 1, Bela + Tac + prednisone (n=5), Group 2, Bela + MMF + prednisone (n=11). All donor, recipient and demographic factors were examined. We compared these two groups in regard to rejection rates, estimated glomerular filtration rate (GFR), creatinine level and protein/Cr ratios before conversion and at 1, 3, 6, 12, 18 and 24 months after conversion. Result: Only one patient in group 2 developed acute cellular rejection. Mean base line GFR for group 1 was 43.6±8.6 ml/min and after 24 months therapy mean GFR was 39.25±10.3 ml/min (p=NS). In group 2, mean baseline GFR was 22.4±1.8ml/min and at 24 months after therapy the mean GFR was 42.04 ±5.5 ml/min (p<0.05). Protein/Cr. ration had not change after conversion in both groups. Conclusion: Conversion to Bela-based immunosuppressive therapy is safe and should be recommended to patients with severe drug intolerance, poor renal function or de novo donor specific antibodies. For renal dysfunction the use of Belatacept with MMF leads to improved renal function which was not seen in the tacrolimus arm.