As a lifelong patient diagnosed with kidney disease at age 9 years, I have experienced in-center hemodialysis at various times in my life. At age 17 years, I had a living donor kidney transplant from my brother. Since then, I have had three more transplants from deceased donors, the last of which was in 1999. As a transplant recipient who has been on immunosuppression the majority of my life, I experienced calcineurin inhibitor (CNI) nephrotoxicity which led to discontinuing the medication and long-term damage to the transplanted kidney. This, in turn, led to me needing another transplant.

I would like to thank the authors of the article titled, “Long-Term Outcomes after Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant Recipients,” published in the CJASN.1 It is truly a privilege and honor to review the manuscript on the conversion to belatacept-based immunosuppression. This is a very important study because not all medications work for all patients. We need precision medicine.

My professional work experience over the past 30 years includes working in many roles in health care. I have served as an organ procurement coordinator, clinical research transplant manager and coordinator, outreach transplant education director, and health care administrator. I am also a newly appointed Patient Voice Editor for CJASN. I was anxious to read the article and review the research findings.

The sample size was small, in which a total of 243 adults converted to belatacept were matched with 243 adult patients maintained on CNI's. At 7 years postconversion to belatacept, allograft outcomes survival was 78%, as compared with 63% in the CNI control group. There were similar patterns seen for safety events in the belatacept versus CNI control groups, including patient death (28% compared with 36%, respectively), active antibody-mediated rejection (6% compared with 7%, respectively), T-cell–mediated rejection (4% versus 4%, respectively), and cardiovascular events and cancer occurrences (9% compared with 11%, respectively) in CNI. However, a higher rate of proteinuria was observed in the belatacept versus CNI control groups (37% compared with 21%).

The study did show that the risk was acceptable to many patients. I would like to see more long-term data, past the 7 years and a larger sample size that also includes pediatrics. However, this is a good start that could give kidney transplant recipients an alternative to CNI's that have nephrotoxicity or delayed graft function. I believe that the more studies we do to compare treatments for kidney transplant and development of new treatments, we can gain further knowledge to make informed and appropriate treatment decisions which can lead to better patient outcomes and quality of life.

Disclosures

Disclosure forms, as provided by each author, are available with the online version of the article at https://links.lww.com/CJN/B873.

Funding

None.

Acknowledgments

The author would like to thank all the patients for participating in the clinical trial to enhance knowledge on kidney transplant treatments.

The content of this article reflects the personal experience and views of the author and should not be considered medical advice or recommendations. The content does not reflect the views or opinions of the American Society of Nephrology (ASN) or CJASN. Responsibility for the information and views expressed herein lies entirely with the author.

Author Contributions

Writing – original draft: Mary Baliker.

Reference 1. Divard G, Aubert O, Debiais-Deschamp C, et al. Long-term outcomes after conversion to a Belatacept-based immunosuppression in kidney transplant recipients. Clin J Am Soc Nephrol. 2024;19(5):628–637. doi:10.2215/CJN.0000000000000411