title: Belatacept in kidney transplantation.
abstract: OBJECTIVE
  In June 2011 the US Food and Drug Administration approved belatacept (Nulojix; Bristol-Myers Squibb, Princeton, New Jersey, USA) for the prophylaxis of organ rejection in adult kidney transplant recipients. This review will discuss the use of belatacept for the prevention of acute rejection as part of a maintenance immunosuppression regimen.
  
  
  RESULTS
  Belatacept is a selective costimulation blocker designed to provide effective immunosuppression while avoiding the toxicities associated with calcineurin inhibitors. Phase 3 trial data have demonstrated that belatacept is noninferior to cyclosporine in 1-year patient and allograft survival. Three-year data demonstrate an ongoing improvement in mean measured glomerular filtration rate in belatacept-treated versus cyclosporine-treated patients. Overall, there seemed to be an improvement in cardiometabolic parameters in patients treated with belatacept compared with cyclosporine. There was a trend toward higher rates of early rejection episodes in patients treated with belatacept. One safety issue that must be considered when using belatacept is the potential for increased risk of posttransplant lymphoproliferative disease, especially in Epstein-Barr virus-seronegative recipients or patients treated with lymphocyte-depleting agents.
  
  
  CONCLUSIONS
  Belatacept is the first new agent available in kidney transplant that may achieve the goal of improved long-term renal function.
authors.affiliation: Kidney Transplant Service, University of California, San Francisco, California 94143-0780, USA.
authors.forename: David
authors.initials: D
authors.lastname: Wojciechowski
authors.forename: Flavio
authors.initials: F
authors.lastname: Vincenti
mesh_terms: D000069594:Abatacept; D000208:Acute Disease; D018106:CD28 Antigens / Q000276:immunology / Q000378:metabolism; D002986:Clinical Trials as Topic; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D018796:Immunoconjugates / Q000008:administration & dosage* / Q000494:pharmacology; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000494:pharmacology; D007668:Kidney / Q000276:immunology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008232:Lymphoproliferative Disorders / Q000139:chemically induced; D015398:Signal Transduction / Q000187:drug effects / Q000276:immunology; D050378:T-Lymphocytes, Regulatory / Q000187:drug effects / Q000276:immunology; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D018106:CD28 Antigens; D018796:Immunoconjugates; D007166:Immunosuppressive Agents; D000069594:Abatacept