Belatacept Conversion in Simultaneous Pancreas-Kidney and Liver-Kidney Transplant Recipients: A Single-Center Feasibility Cohort and Narrative Review.
- 1Division of Nephrology, University Hospital Zurich, Zurich, Switzerland.
- 2Division of Nephrology, Cantonal Hospital Lucerne, Lucerne, Switzerland.
- 3Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Abstract
Background
Calcineurin inhibitor (CNI) nephrotoxicity drives long-term kidney-function decline after simultaneous pancreas-kidney (SPK) and liver-kidney (LK) transplantation, but belatacept conversion, as an alternative strategy, is poorly studied in these recipients, whose non-kidney allograft rejection risk differs.Methods
We retrospectively studied six SPK and six LK recipients converted from CNI- to belatacept-based immunosuppression and analyzed the cohorts separately alongside a narrative review of published SPK/LK conversion experiences. Outcomes were estimated glomerular filtration rate (eGFR) trajectories and slopes, donor-specific antibodies (DSA) and rejection, pancreatic, hepatic and metabolic parameters, infections, and survival, reported descriptively with exploratory estimates and 95% confidence intervals (CI).Results
Conversion occurred a median of 64 (SPK) and 89 (LK) months after transplantation, always with a transient low-dose CNI overlap (target trough 3-4 ng/ml). In SPK recipients, median eGFR rose from 45.4 to 55.5 mL/min/1.73m² and the median eGFR slope changed from -3.9 to +5.6 mL/min/year (mixed-model slope change +12.6, 95% CI 2.9 to 22.3); in LK recipients, from 38.8 to 46.3 and from -3.1 to +4.1 (estimate +6.3, 95% CI -4.2 to 16.7). No new DSA developed; pre-existing DSA declined or remained stable. Pancreatic and liver function stayed stable. Two infections in LK recipients (Pneumocystis pneumonia, adenovirus) were possibly belatacept-aggravated. Over a median 25 months, 8/12 (67%) remained on belatacept.Conclusions
Late belatacept conversion with a transient low-dose CNI overlap was feasible in selected SPK and LK recipients and was associated with stable-to-improved kidney function without a pancreatic or hepatic safety signal. The uncontrolled design supports feasibility, not efficacy.
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BibTeX
@article{harmacek2026belatacept,
title = {{Belatacept Conversion in Simultaneous Pancreas-Kidney and Liver-Kidney Transplant Recipients: A Single-Center Feasibility Cohort and Narrative Review.}},
author = {Dusan Harmacek and Elena Rho and Seraina von Moos and Severin Simmler and Thomas Welte and Fabian Rössler and Thomas Schachtner and Lukas Weidmann},
journal = {Clinical transplantation},
year = {2026},
month = oct,
doi = {10.1111/ctr.70719},
url = {https://europepmc.org/article/MED/42893532},
note = {CC BY},
}
RIS
TY - JOUR
TI - Belatacept Conversion in Simultaneous Pancreas-Kidney and Liver-Kidney Transplant Recipients: A Single-Center Feasibility Cohort and Narrative Review.
AU - Dusan Harmacek
AU - Elena Rho
AU - Seraina von Moos
AU - Severin Simmler
AU - Thomas Welte
AU - Fabian Rössler
AU - Thomas Schachtner
AU - Lukas Weidmann
PY - 2026
DA - 2026/10/01
JO - Clinical transplantation
DO - 10.1111/ctr.70719
UR - https://europepmc.org/article/MED/42893532
AB - Background Calcineurin inhibitor (CNI) nephrotoxicity drives long-term kidney-function decline after simultaneous pancreas-kidney (SPK) and liver-kidney (LK) transplantation, but belatacept conversion, as an alternative strategy, is poorly studied in these recipients, whose non-kidney allograft rejection risk differs.Methods We retrospectively studied six SPK and six LK recipients converted from CNI- to belatacept-based immunosuppression and analyzed the cohorts separately alongside a narrative review of published SPK/LK conversion experiences. Outcomes were estimated glomerular filtration rate (eGFR) trajectories and slopes, donor-specific antibodies (DSA) and rejection, pancreatic, hepatic and metabolic parameters, infections, and survival, reported descriptively with exploratory estimates and 95% confidence intervals (CI).Results Conversion occurred a median of 64 (SPK) and 89 (LK) months after transplantation, always with a transient low-dose CNI overlap (target trough 3-4 ng/ml). In SPK recipients, median eGFR rose from 45.4 to 55.5 mL/min/1.73m² and the median eGFR slope changed from -3.9 to +5.6 mL/min/year (mixed-model slope change +12.6, 95% CI 2.9 to 22.3); in LK recipients, from 38.8 to 46.3 and from -3.1 to +4.1 (estimate +6.3, 95% CI -4.2 to 16.7). No new DSA developed; pre-existing DSA declined or remained stable. Pancreatic and liver function stayed stable. Two infections in LK recipients (Pneumocystis pneumonia, adenovirus) were possibly belatacept-aggravated. Over a median 25 months, 8/12 (67%) remained on belatacept.Conclusions Late belatacept conversion with a transient low-dose CNI overlap was feasible in selected SPK and LK recipients and was associated with stable-to-improved kidney function without a pancreatic or hepatic safety signal. The uncontrolled design supports feasibility, not efficacy.
SN - 0902-0063
SN - 1399-0012
ER -