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Master Thesis

Switch des anti-calcineurines au Belatacept chez les patients transplantés rénaux présentant un rejet humoral chronique-actif

Abstract : Chronic-active Antibody Mediated Rejection (ca-ABMR) in Kidney Transplant (KT) lacks effective treatment. Hence, latest guidelines recommend usual nephroprotective therapies in which limiting nephrotoxicity is paramount. Belatacept which usefulness in Extended Criteria Donors and chronic vascular changes has been shown could be an interesting alternative to Calcineurin Inhibitors (CNI). This study aims to evaluate if switch from CNI to Belatacept is beneficial on KT survival and function in ca-ABMR. Methods: Patients with the diagnosis of ca-ABMR and switched to Belatacept between 2012 and 2020 in four French KT centers were retrospectively included. Results: Nineteen patients were switched from CNI to Belatacept and compared to 58 controls with a median follow-up of 29 [4 - 125] months. Biopsy was performed 78 [4 - 140] months after KT, with a mean estimated Glomerular Filtration Rate (eGFR) of 36.2 ± 15.6 mL/min/1.73m2. There was no difference of eGFR at baseline, one, two and three years: 31.2 ± 14.5, 26.0 ± 19.7, 22.4 ± 19.5 and 22.1 ± 24.9 mL/min/1.73m2, respectively, in the Belatacept-treated group, versus 36.1 ± 15.7, 29.1 ± 18.6, 23.4 ± 18.0 and 17.5 ± 18.0 mL/min/1.73m2 in the CNI-treated group. The delta of eGFR between 3 years and Day 0 was -9.1 ± 14.3 mL/min/1.73m2 in the Belatacept-treated group versus -18.6 ± 15.1 mL/min/1.73m2, p = 0.05. This difference was increased when focusing on the subgroup with a baseline eGFR ≥ 35 mL/min/1.73m2: 3.3 ± 19.2 versus -25.3 ± 17.1 mL/min/1.73m2, p = 0.005. However, death-censored survival was similar in the two groups at one, two and three years: 81.3%, 71.4% and 41.6%, respectively, in the Belatacept-treated group, versus 84.4%, 66.0% and 47.1%, p = 0.6. Conclusion: Switch from CNI to Belatacept may lower decline of eGFR at three years, especially when it is started at an early stage. However, it does not appear to have an effect on death-censored KT survival.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02965193
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Submitted on : Tuesday, October 13, 2020 - 9:47:25 AM
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  • HAL Id : dumas-02965193, version 1

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Tristan de Nattes. Switch des anti-calcineurines au Belatacept chez les patients transplantés rénaux présentant un rejet humoral chronique-actif. Médecine humaine et pathologie. 2020. ⟨dumas-02965193⟩

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