title: Does belatacept improve outcomes for kidney transplant recipients? A systematic review.
abstract: BACKGROUND
  Belatacept was intended to provide better outcomes for kidney transplant (KT) recipients by allowing minimization/withdrawal of calcineurin inhibitors (CNI) and steroids.
  
  
  METHODS
  We searched for randomized controlled trials (RCTs) in adult KT comparing belatacept with CNIs. Methodological quality was assessed. Meta-analyses were performed to calculate odds ratios (OR) and mean differences (MD).
  
  
  RESULTS
  Six RCTs were included. Pooled analyses found no differences for acute rejection at any time point. Renal function [Calculated glomerular filtration rate (cGFR)] was better with belatacept at 12 and 24 months (MD = 11.7 and 13.7 ml/min/1.73 m(2) ). New onset diabetes after transplantation was lower with belatacept at 12 months (OR = 0.43). Systolic and diastolic blood pressures were lower at 12 months (MD -7.2 and -3.1 mmHg) as were triglycerides at 12 and 24 months (MD = -32.9 and -41.7 mg/dl). Total and low-density lipoprotein cholesterol were lower with belatacept at 24 months (MD = -19.8 and -10.6 mg/dl). There were no differences for other outcomes.
  
  
  CONCLUSIONS
  Limited available data suggest a potential benefit for belatacept by reducing the risk of CNI toxicity, especially renal function, without evidence of increased acute rejection. There were no safety issues apart from a possible risk of post-transplant lymphoproliferative disorder in Epstein-barr virus-seronegative recipients. Further studies are required to confirm this benefit.
authors.affiliation: Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, University of London, London, UK.
authors.forename: Nishanthi
authors.initials: N
authors.lastname: Talawila
authors.affiliation: Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, University of London, London, UK.|Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Liset H M
authors.initials: LH
authors.lastname: Pengel
mesh_terms: D000069594:Abatacept / Q000627:therapeutic use*; D000328:Adult; D001794:Blood Pressure; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D003971:Diastole; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000628:therapy*; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D065095:Calcineurin Inhibitors; D008078:Cholesterol, LDL; D007166:Immunosuppressive Agents; D014280:Triglycerides; D000069594:Abatacept
keywords: belatacept; calcineurin inhibitor; cyclosporine; immunosuppression; kidney transplantation; tacrolimus