Does Belatacept Provide a Safe Renal Sparing Immunosuppression in Lung Transplant Recipients? A Single-Center Experience

Purpose Belatacept reduces calcineurin inhibitor (CNI) nephrotoxicity in kidney transplant recipients. However, its use in lung transplantation is extremely limited and it remains unclear whether it can provide a safe and effective renal sparing immunosuppression in patients with chronic kidney disease. Methods This is a prospective cohort study of patients who were started on Belatacept with lower CNI goals post lung transplantation at our institution between 2018 and 2020. Institutional IRB approval was obtained. Patients aged 18 years or older were included and multiorgan recipients were excluded. Continuous data was reported as median and categorical data as proportions. Paired data analyses that include Wilcoxan signed rank test and McNemar's test were performed. Results 85 patients satisfied the inclusion and exclusion criteria. Median time to initiation of Belatacept after transplantation was 293 days, interquartile range (IQR) (148-611). The cohort was followed for a median of 311 days IQR (182-465). 28 patients (33%) stopped the infusion with the majority due to infectious complications. There was a median of 1ml increase in GFR (p=0.68). The FEV1 increased a median of 40ml during the same duration (p=0.0034). Conclusion In this large cohort, Belatacept provided an effective renal sparing immunosuppression. There was no decline in graft function with stabilization of GFR. There was a tendency towards a higher rate of opportunistic infections and cancers; however, this did not achieve statistical significance.