Belatacept‐based immunosuppression does not confer increased risk of BK polyomavirus‐DNAemia relative to tacrolimus‐based immunosuppression

Abstract

AbstractBackgroundThe effect of belatacept on BK polyomavirus (BKPyV) control remains largely unknown.MethodsThis is a propensity matched retrospective cohort study in adult kidney transplant recipients (KTR) transplanted between 2016–2020 who received a belatacept‐ versus tacrolimus‐based immunosuppression regimen. A continuous time multi‐state Markov model was used to evaluate BKPyV replication dynamics (BKPyV‐dyn). Three BKPyV‐dyn states were defined: BKPyV‐dyn1 (viral load <3 log10), BKPyV‐dyn2 (viral load ≥ 3 log10 and ≤4 log10), and BKPyV‐dyn3 (viral load >4 log10).ResultsTwo hundred eighty KTR on belatacept‐ and 280 KTR on tacrolimus‐based regimens were compared. The probability of transitioning between BKPyV‐dyn states and time spent in each state in both groups was comparable. Total duration in BKPyV‐dyn‐1 was 632.1 days (95% CI 612.1, 648.5) for belatacept versus 615.2 days (95% CI 592.5, 635.8) for tacrolimus, BKPyV‐dyn‐2 was 49.2 days (95% CI 41.3, 58.4) for belatacept versus 55.6 days (95% CI 46.5, 66.8) for tacrolimus, and BKPyV‐dyn‐3 was 48.7 days (95% CI 37.1, 363.1) for belatacept versus 59.2 days (95% CI 45.8, 73.5) for tacrolimus. BKPyV associated nephropathy (PyVAN) occurred in 3.9% in belatacept‐ and 3.9% tacrolimus‐treated KRT (P > .9).ConclusionsCompared with tacrolimus‐based immunosuppression, belatacept based immunosuppression was not associated with increased risk of BKPyV‐DNAemia or nephropathy. image