D141 - Renal Function at Eight Years from a Randomized Multicenter Trial of Belatacept-Based CNI Free and Early Steroid Withdrawal Immunosuppression

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Author Block: W. Schwieterman¹, M. Warden¹, A. Shields², T. Shi¹, E. Woodle¹, ¹University of Cincinnati College of Medicine, Cincinnati, OH, ²The Christ Hospital, Cincinnati, OH
*Purpose: Previous trials have shown that belatacept-based immunosuppression in kidney transplantation was in both primary treatment and after CNI-conversion was associated with improved long term allograft function compared to cyclosporine-based immunosuppression. However, long term data on primary belatacept immunosuppression compared to standard-of-care tacrolimus have not been reported. Herein we examine long-term allograft function at 8 years between belatacept- and tacrolimus-based immunosuppression regimens.
*Methods: Eight-year results from a randomized multicenter trial were analyzed for renal function [SrCr, calculated eGFR (MDRD)] and immunologic events (BPAR and DSA). MMF with early steroid withdrawal was compared across ALEM/BELA, r-ATG/BELA, or r-ATG/TAC groups. In graft failure/loss, eGFR was set to 0; patients lost to follow-up were excluded.
*Results: 126 patients with eight-year follow-up were analyzed by intention to treat (ITT). No demographic differences were observed by group. Eight-year outcomes are reported in Table 1. Results of allograft function via slope-based analysis showed an overall decrease in mean eGFR from month 1 to month 96 in all treatment groups for ITT and censored for death and graft loss (Figure 1A, B). Similar analyses were performed by donor type, presence of BPAR or DSA (Figure 1C-H). The greatest eGFR decline occurred in patients experiencing BPAR and DSA. Rates of BPAR for patients in the r-ATG/BELA group were significantly higher than the r-ATG/TAC group. Renal allograft function (eGFR) was not statistically different between groups at 8 years (Table 1).
*Conclusions: At 8 years, all groups showed progressively declining eGFR, with the steepest decline in patients with DSA or BPAR; BPAR was most frequent in the r-ATG/BELA group. However, rATG+BELA patients without BPAR experienced significantly higher eGFR’s at several time points. Overall outcomes at 8-years were similar between groups, indicating that belatacept with early steroid withdrawal is a viable alternative to calcineurin-inhibitor based immunosuppression in kidney transplantation.