Obesity is associated with a higher incidence of rejection in patients on belatacept: A pooled analysis from the BENEFIT/BENEFIT-EXT clinical trials

Nicholas W Lange; Kristen King; Syed Ali Husain; David M Salerno; Demetra S Tsapepas; Jessica Hedvat; Miko Yu; Sumit Mohan

doi:10.1016/j.ajt.2024.02.015

Obesity is associated with a higher incidence of rejection in patients on belatacept: A pooled analysis from the BENEFIT/BENEFIT-EXT clinical trials

Am J Transplant. 2024 Feb 21:S1600-6135(24)00157-6. doi: 10.1016/j.ajt.2024.02.015. Online ahead of print.

Authors

Nicholas W Lange¹, Kristen King², Syed Ali Husain², David M Salerno³, Demetra S Tsapepas⁴, Jessica Hedvat³, Miko Yu², Sumit Mohan⁵

Affiliations

¹ Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA. Electronic address: nil9037@nyp.org.
² Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA.
³ Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA.
⁴ Columbia University Renal Epidemiology Group, New York, New York, USA; Division of Transplantation, Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Department of Quality, NewYork-Presbyterian Hospital, New York, New York, USA.
⁵ Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.

PMID: 38387620
DOI: 10.1016/j.ajt.2024.02.015

Abstract

Though belatacept is administered with a weight-based dosing schema, there has been higher clearance reported in obese patients. Therefore, we evaluated the association between body mass index (BMI) and transplant outcomes in kidney transplant recipients who were randomized to cyclosporine- or belatacept-based immunosuppression in the BENEFIT and BENEFIT-EXT randomized clinical trials. A total of 666 and 543 patients underwent randomization and transplantation in BENEFIT and BENEFIT-EXT, respectively, of which 1056 had complete data and were included in this analysis. Patients were grouped categorically according to BMI: <25, 25 to <30, and ≥30 kg/m². BMI did influence both the incidence and severity of acute rejection. Obese patients with BMI >30 kg/m² in the low intensity belatacept group experienced significantly more rejection at 12 months than did patients with BMI <25 kg/m² or BMI 25 to <30 kg/m². In both the moderate intensity belatacept and low intensity belatacept groups, obese patients with BMI >30 kg/m² experienced significantly more severe acute rejection than did patients with BMI < 25 kg/m² or BMI 25 to <30 kg/m². These results suggest that obese kidney transplant recipients are at an increased risk for acute rejection when under belatacept-based immunosuppression when compared to nonobese patients.

Keywords: Belatacept; kidney transplant; obesity; rejection.