Belatacept prophylaxis against organ rejection in adult kidney-transplant recipients

ABSTRACT

End-stage renal disease is a major health problem worldwide, with kidney transplantation being the treatment of choice. Calcineurin inhibitors are still the cornerstone of immunosuppressive therapy. However, they have well-known nephrotoxic affects and increase the risk of cardiovascular disease and cancer. In contrast, belatacept is a biological immunosuppressive agent that inhibits the T-cell co-stimulation. It is approved by the US Food and Drug Administration and the European Medicine Agency for use in adult kidney-transplant recipients to prevent acute rejection. Developmental studies show that belatacept is as efficient as calcineurin inhibitors at preventing acute rejection. In addition, kidney function is better and cardiovascular risk factors are reduced in patients given belatacept. Herein, the authors review the published evidence concerning the efficacy and safety of belatacept and discuss its potential specific indications.

KEYWORDS:

• Immunosuppressive therapy
• belatacept
• co-stimulation
• rejection
• kidney transplantation
• calcineurin inhibitor avoidance

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Belatacept is efficient at preventing acute rejection in de novo and maintenance kidney-transplant patients.

• Long-term kidney function is better in patients who receive belatacept compared with cyclosporine A.

• Conversion from CNIs to belatacept is safe and efficient.

• The incidence of DSAs is low in patients treated by belatacept.

• The cardiovascular profile is improved in patients given belatacept.

• Belatacept cannot be given to EBV seronegative patients receiving a kidney from an EBV-seropositive donor because of the increased risk of post-transplant lymphoma.