Belatacept Post Kidney Transplantation

Abstract

Objective: To review the use of belatacept as an alternative to calcineurin inhibitor-based regimens for maintenance immunosuppression in renal transplant recipients. Data Sources:To provide an extensive overview of the pharmacology, pharmacokinetics, efficacy, and safety of belatacept, a MEDLINE/PubMed search (1980( -December 2011 was performed for all articles evaluating belatacept's properties and patient outcomes, as well as abstracts from recent meetings, using key words belatacept, pharmacology, efficacy, pharmacokinetics, and safety.Study Selection/Data Extraction: Phase 2 and 3 studies in humans describing use, adverse reactions, pharmacology, pharmacokinetics, efficacy, and safety of belatacept were identified and reviewed. Other articles were identified through PubMed.Data Synthesis: Belatacept, a costimulation blocker, is a biologic recombinant fusion protein that has been shown to prevent acute cellular rejection in kidney transplant recipients and preserve renal function. It was recently approved by the FDA as an antirejection immunosuppressant agent for use in kidney transplant recipients. It is the first biologic agent used for maintenance immunosuppression. It acts as an antagonist to CD80 and CD86 receptors located on the surface of antigen presenting cells, thereby blocking CD28 T-cell activation and, thus, preventing acute rejection. In comparison with patients receiving other current therapies, patients on belatacept have demonstrated superior renal function with comparable outcomes in patient and graft survival. Conclusions:Belatacept has potential for use as an alternative to current maintenance immunosuppression regimens, with potentially fewer adverse effects.