Short-term decreased post transplant lymphoproliferative disorder risk after kidney transplantation using two novel regimens.

Background: Belatacept is employed alongside calcineurin inhibitor (CNI) therapy to prevent graft rejection in kidney transplant patients who are Epstein-Barr virus (EBV) seropositive. Preliminary data suggested that rates of post-transplant lymphoproliferative disorder (PTLD) were higher in individuals treated with belatacept compared to CNI therapy alone.

Methods: The records of 354 adults who underwent kidney only transplantation from January 2015 through September 2021 at one medical center were evaluated. Patients underwent treatment with either low-doses of mycophenolate, tacrolimus and sirolimus (B, n = 235) or low-doses of mycophenolate, tacrolimus and belatacept (B, n = 119). All recipients underwent induction with antithymocyte globulin and a rapid glucocorticosteroid taper. Relevant donor and recipient information were analyzed and endpoints of PTLD were assessed.

Results: There were no cases of PTLD in either cohort within the study period. Recipients in the belatacept cohort experienced lower estimated glomerular filtration rates at 12 months (B: 67.48 vs. B: 59.10, p = 0.0014). Graft failure at 12 (B: 1.28% vs. B: 0.84%, p = 1.0) and 24 months (B:2.55% vs. B: 0.84%, p = 0.431) were similar. There was no difference in rejection rates at 12 (B: 1.27% vs. B: 2.52%, p = 0.408) or 24 months (B: 2.12% vs. B: 2.52%, p = 1.000). Both groups had similar rates of malignancy, mortality and CMV/BK viremia.

Conclusion: Non-belatacept (MMF, tacrolimus and sirolimus) and belatacept-based (MMF, tacrolimus and belatacept) regimens do not appear to pose any increased risk of early onset PTLD. Both cohorts benefited from low rates of rejection, malignancy, mortality and graft failure. Recipients will continue to be monitored as PTLD can manifest as a long-term complication.