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excited about to learning events upcoming. Explore Transplant training the summer & Duke Transplant Summit in October 2018. Great teaching/learning opportunities. #askasn

excited to be here. hope Swapnil Hiremath @hswapnil.medsky.social will be more excited about bela after this?! #askasn

emphasis on middle: bela TA cept #AskASN

agree that the VA was a nice summary of the studies done for FDA approval #AskASN

At duke, we use it de novo & in switch protocols. works great both ways, but different considerations when used in these different contexts. #AskASN

our de novo use of bela is exclusively outside of research. de novo use is with campath induction & sirolimus maintenance. no steroids. not what the trials used. #askasn

can give in an infusion center OR via home health infusion services. #askasn

no FDA indiction for use outside of kidney transplant as increased liver rejections. never trialed in heart or lung, but makes sense as they really like to run tacro troughs high. #AskASN

home health works, but the insurance coverage has to be private... #AskASN

armored truck, that's funny Joel. not as expensive as eculizumab, but close... #AskASN

emory uses bela, tacro, MPA + steroids & then drops the tacro after 6 (or 9 months) to address the early rejections seen in the trials. we us campth to avoid those early rejections. #AskASN

the rejections seen in the BENEFIT/EXT were usually early, tended to be severe, but responded nicely to treatment. rejection rates thereafter non existent. GFR better @ one & seven year follow up. #AskASN

infection rates similar to calcineurin inhibitor regimens (both in published literature + in our experience). we use sirolimus for this reason. #AskASN

agree that emory uses the early tacro to prevent rejections. they were not using T cell depletion (I don't think) for induction. #AskASN

not sure it refutes the rejection = more later loss, but the bela group in the extension of the BENEFIT trial did not have any more graft loss & GFR was better! #AskASN

follow up for up to 10 years, but 7 was the mean. need to confirm the GFR difference but on the order of 20mL/min delta (don't quote this number yet!) #AskASN

no SQ available. not sure if this is in the works... #AskASN

not the best/right drug for everyone, for sure. I think it has a role, however! #AskASN

it was great! thanks for having me! #AskASN

i broke a sweat on number 468! #AskASN