Conversion au bélatacept chez les transplantés rénaux stables : expérience dans la vraie vie

Abstract : Calcineurin inhibitor (CNI) have renal toxicity and metabolic side effects affecting graft and patient survival. Belatacept, a new immunosuppressor without renal and metabolic side effect, has been recently approved for preventing allograft rejection. This treatment allows, in comparison with cyclosporin, a better kidney graft function, a reduced incidence of donor specific antibody, despite an increased acute cellular rejection rate. The main objective is to assess, in a real-life scenario, the effect of late conversion to belatacept in stable kidney transplant recipients under calcineurin inhibitors. We also assess if urinary CXCL-9 monitoring could highlight patients at risk of acute cellular rejection under belatacept. We realised a retrospective study on 35 kidney graft transplant recipients with mainly chronic graft dysfunction who were under CNI. Our study shows that late conversion to belatacept leads to kidney graft function stabilization, a decreased of HbA1c and systolic blood pressure at 12 months post conversion. Significantly renal function improvement was observed in sub-group of chronic graft dysfunction. After conversion, no side effect was observed. Only one acute rejection occured. Urinary CXCL-9 rate remains negative in all patients without renal event.
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Master Thesis
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Guillaume Rigault. Conversion au bélatacept chez les transplantés rénaux stables : expérience dans la vraie vie. Médecine humaine et pathologie. 2018. ⟨dumas-01959067⟩

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