Belatacept-versus cyclosporine-based immune suppression in renal transplant recipients with pre-existing diabetes

Lionel Rostaing, Hans H. Neumayer, Rafael Reyes-Acevedo, Barbara Bresnahan, Sander Florman, Stefan Vitko, Michael Heifets, Jun Xing, Dolca Thomas, Flavio Vincent

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24 Scopus citations

Abstract

Background and objectives Renal transplant recipients with pre-existing diabetes (PD) have reduced graft survival and increased risk of mortality and ischemic heart disease compared with nondiabetic transplant recipients. To assess the effect of belatacept in this high-risk group, we evaluated outcomes of the subpopulation with PD from previously published BENEFIT and BENEFIT-EXT trials.Design, setting, participants, & measurements A post hoc analysis evaluated pooled data from BENEFIT (living donors or standard criteria donors) and BENEFIT-EXT (extended criteria donors). Patients were randomized to receive cyclosporine or a more intensive (MI) or less intensive (LI) belatacept regimen. Results Of 1209 intent-to-treat patients, 336 had PD. At 12 months, the belatacept LI arm demonstrated a numerically higher rate of patients surviving with a functioning graft (90.4% MI [103 of 114], 92.8% LI [90 of 97], and 80.8% cyclosporine [101 of 125]), and fewer serious adverse events than cyclosporine or MI patients. Three cases of posttransplant lymphoproliferative disorder were reported in LI patients, one involving the central nervous system. Higher rates (% [95% confidence interval]: 22.8% MI [15.1 to 30.5]; 20.6% LI [12.6 to 28.7]; 14.4% cyclosporine (8.2 to 20.6]) and grades of acute rejection were observed with belatacept. Measured GFR (ml/min per 1.73 m2, 59.8 MI; 62.5 LI; 45.4 cyclosporine), and cardiovascular risk profilewere better for belatacept versus cyclosporine. Conclusions In post hoc analysis of patients with PD, patient/graft survival and renal function at 12 months were numerically higher with belatacept versus cyclosporine, but not statistically significant. Further study is necessary to confirm the benefits belatacept may provide in these patients.

Original languageEnglish
Pages (from-to)2696-2704
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number11
DOIs
StatePublished - 1 Nov 2011

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