Calcineurin inhibitors (CNIs) have been the backbone immunosuppressant for solid organ transplant recipients for decades. Long-term use of CNIs unfortunately is associated with multiple toxicities, with the biggest concern being CNI-induced nephrotoxicity. Belatacept is a novel agent approved for maintenance immunosuppression in renal transplant recipients. In the kidney transplant literature, it has shown promise as being an alternative agent by preserving renal function and having a minimal adverse effect profile. There are emerging studies of its use in other organ groups, particularly liver transplantation, as well as using with other alternative immunosuppressive strategies. The purpose of this review is to analyze the current literature of belatacept use in solid organ transplantation and discuss its use in current practice.
This review summarizes the efficacy and safety of de novo and conversion use of belatacept after solid organ transplantation, including challenges associated with chronic monthly infusions, effects on treatment adherence, associated costs, and ongoing clinical trials exploring innovative immunosuppressive strategies.
1 Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC.
2 Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC.
3 Department of Surgery, Medical University of South Carolina, Charleston, SC.
4 Department of Pharmacy, Ralph H Johnson VAMC, Charleston, SC.
5 Department of Pharmacy Practice and Outcomes Sciences, Medical University of South Carolina, Charleston, SC.
Received 21 December 2018. Revision received 30 April 2018.
Accepted 16 May 2018.
The authors declare no funding or conflicts of interest.
All authors were involved with analyzing the literature, interpreting the data, and writing the article. C.P., N.P., and N.A.P. were involved with revising the article. C.P. was involved with coordination and final editing of the manuscript. All authors agreed upon final approval of the version submitted.
Correspondence: Caroline P. Perez, PharmD, BCPS, Solid Organ Transplant, Medical University of South Carolina, 150 Ashley Ave, MSC 584l, Charleston, SC 29425. (firstname.lastname@example.org).