Etcprotocols.org



PROTOCOL TITLE: Kidney and Pancreas Post Transplant: Belatacept dosing interval in transplant patients with COVID-19 APPLICABLE FACILITIES:?EHC?EDH?EHH?EHI?EHN?EJCH?ELTAC?ESJH?EUH?EUHM?EUHS?EUOSH?EWWH ?RJV-ERH?RJV-ESOP?TEC/ESAEFFECTIVE DATE: 08/05/2020ORIGINATION DATE: 08/05/2020CATEGORY: Diagnostic/Therapeutic/Preventive, Medication GuidelinesLEVEL: Independent SCOPE: All transplant program physicians, practitioners and clinical staff members PURPOSE: This protocol provides guidelines on the timing of belatacept infusion for patients who are diagnosed with COVID-19 during their belatacept infusion window (+/- 7 days since last infusion)PROTOCOL: TARGET PATIENT POPULATIONS: Kidney Transplant recipients with recent diagnosis of COVID-19 who are maintained on belatacept maintenance immunosuppression regimen.Belatacept Management Guidelines:Patients on maintenance Belatacept q 1 month infusionconsider next infusion up to 2 weeks past infusion due dateconsider lowering MMF (maintain > or = 500mg bid)continue to maintain prednisone 5mgBelatacept q 2 monthsconsider next infusion up to 2 weeks past infusion due date, not to exceed 10 weeks since last infusionconsidering maintaining current dose of MMF ( > or = 500 mg bid) if clinically indicated, can consider lowering MMF (maintain > or = 500mg bid)continue to maintain prednisone 5mgIf Patients on q 1 month and q 2 months infusion are unable to get belatacept infusion 2 weeks past infusion due date consider introducing tacrolimus with trough goal 3-5Ensure adequate dosing of MMF and prednisone if belatacept dosing interval is extending beyond 2 months Ensure immunosuppression dose is adjusted back to maintenance regimen after patient has recovered Ensure patient resumes belatacept infusion schedule as previously scheduled i.e +/- 7 days around transplant anniversary dateWorkflow:Outpatient Clinic will notify belatacept team, long or short-term post kidney team and primary transplant nephrologist for further recommendations and follow up guidelines.RELATED POLICIES / PROCEDURES:DEFINITIONS: N/AREFERENCES AND SOURCES OF EVIDENCE:Adams, AB et al.? Am J Transplant 2017 Nov;17(11):2922-36Cunningham, KC et al.? Pharmacotherapy 2016;36(7):823-9.Gabardi, S et al.? Am J Health-Syst Pharm 2011;68:211-8Kaufman DB et al. Am J Transplant 2003;3:855-64Vincenti, F et al. NEJM 2016 Jan 28; 374:333-343KEY WORDS: belatacept, kidney transplant, immunosuppression, covid ................
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