title: Belatacept : a new biological agent for maintenance immunosuppression in kidney transplantation.
abstract: BACKGROUND
  Over the past decades, calcineurin inhibitors (CNIs) have become the cornerstone of transplant immunosuppression. CNIs can exert negative effects on chronic allograft function along with cardiovascular (CV) and metabolic adverse effects. Belatacept , a selective co-stimulation blocker of T cells, is the first US FDA (06/2011) and EMEA (06/2011) approved biologic agent for maintenance immunosuppression in renal transplantation.
  
  
  METHODS
  The authors critically reviewed the literature over the last few years comparing belatacept with current standard of maintenance immunosuppression including CNIs in kidney transplantation.
  
  
  CONCLUSIONS
  Despite the increased incidence and severity of acute rejection with belatacept in Phase II and III studies, a better preservation of GFR and reduced incidence of chronic allograft nephropathy was observed as compared with CNIs. Patient and graft survivals were similar over 3- and 5-year follow-up post-transplantation. Incidence of adverse events were similar between the groups, but the risk of post-transplant lymphoproliferative disorder, predominantly involving CNS, was higher in Epstein-Barr virus seronegative recipients on belatacept, especially with a more intensive regimen. CV and metabolic end points were more favorable in belatacept versus CNI groups with similar incidences of diabetes after transplantation. Belatacept seems to be a promising drug for the future, but long-term outcomes are awaited.
authors.affiliation: Allegheny General Hospital, Division of Nephrology and Hypertension, Department of Medicine, Pittsburgh, PA 15212, USA.
authors.forename: Swati
authors.initials: S
authors.lastname: Arora
authors.forename: Bhargavi
authors.initials: B
authors.lastname: Tangirala
authors.forename: Liliana
authors.initials: L
authors.lastname: Osadchuk
authors.forename: Kalathil K
authors.initials: KK
authors.lastname: Sureshkumar
mesh_terms: D000069594:Abatacept; D002986:Clinical Trials as Topic; D006801:Humans; D018796:Immunoconjugates / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation
chemical_list: D018796:Immunoconjugates; D007166:Immunosuppressive Agents; D000069594:Abatacept