The following is a summary of the “Cardiovascular Risk Following Conversion to Belatacept From a Calcineurin Inhibitor in Kidney Transplant Recipients: A Randomized Clinical Trial,” published in the January 2023 issue of Journal of kidney medicine by Bredewold, et al.

A belatacept-based immunosuppressive regimen has been linked to improved CV risk factors in kidney transplant recipients (KTRs), in comparison to calcineurin inhibitor (CNI)-based regimens. Our goal was to use a validated model created for KTRs to compare the calculated CV risk of belatacept and CNI (predominantly tacrolimus) treatments. Trial design: prospective, randomized, open-label, parallel-group, investigator-initiated, multinational.

Patients 3-60 months post-transplant on tacrolimus or cyclosporine A who had stable graft function (estimated glomerular filtration rate > 20 mL/min/1.73 m2) were considered for inclusion. Changes in conventional markers of CV health and measures of arterial stiffness were compared with changes in the estimated risk of major adverse CV events and all-cause mortality over the next 7 years. There were no significant differences in the risk of major adverse CV events or mortality between the treatment groups among the 105 KTRs who were randomly assigned to them. 

After receiving belatacept, patients experienced lower diastolic blood pressure compared to those who received CNI. Standard CV risk factors, such as kidney transplant function, showed similar mean changes between the 2 treatment groups. There were 4 episodes of acute rejection in the belatacept group, 2 of which were severe rejections that resulted in graft loss. Incorporating belatacept into treatment had no discernible effect on the predicted CV risk. The rejection rate was higher in the belatacept group, and their diastolic blood pressure was lower in the middle and on the periphery.

Source: sciencedirect.com/science/article/pii/S2590059522002072