Belatacept: Where the BENEFITS Outweigh the Risk

Belatacept Conversion in Kidney Transplant Recipients with Congestive Heart Failure: Survival and 30-Day Readmission Outcomes

Calcineurin inhibitors (CNIs) are deleterious to cardiovascular risk in kidney transplant recipients (KTRs). Data on the impact of belatacept on KTRs with congestive heart failure (CHF) are scarce. We hypothesized that conversion to belatacept will have better patient and graft survival and a lower rate of readmissions within 30 days after discharge compared with long-term CNI use. We analyzed data from KTRs admitted to CHF between 2014 and 2019. A total of 28 recipients converted to belatacept and were matched with 339 who continued on CNIs. There was no significant difference in patient demographics, or primary disease between the two groups. The adjusted hazard ratio associated with conversion was (0.87 [95% CI, 0.35-2.11] for death, (0.91, [95% CI, 0.39-2.13] for graft failure and (adjusted hazard ratio, 1.91, [95% confidence interval (CI), 0.90-4.06]) for 30-day postdischarge readmission between the two groups. Patients converted to belatacept were at a higher risk of rejection (adjusted hazard ratio, 13.8; 95% CI, 7.48-25.3). Patient and graft survival and 30-day readmission after CHF hospital discharge did not differ significantly between belatacept conversion and CNI continuation. The incidence of rejection was higher in the belatacept conversion group, suggesting a need for closer follow-up of patients on belatacept therapy.

Inefficiency Rates of Biological Immunosuppressive Induction Agents Used in Organ Transplantation: A Pharmacovigilance Study

Effective immunosuppressant pharmacotherapy is essential for successful organ transplantation. Background/Objectives: Generally, induction therapy includes basiliximab (BAS) or anti-thymocyte globulin (THY). However, other biological molecules have been used to accelerate firm immunosuppression. A reduced effectiveness of these induction agents increases the risk of graft rejection. This study aims to evaluate the ineffectiveness rate of biological molecules based on spontaneous reports uploaded to the EudraVigilance database. Methods: Specific topics related to the safety profiles of alemtuzumab, BAS, belatacept, and THY were analyzed. A total of 23 preferred terms describing drug resistance, drug ineffectiveness, and transplant rejection were used as the inclusion criteria. Descriptive and disproportionality analyses were performed. Results: Regarding the four molecules, 18,564 safety reports were communicated, with n = 5089 (27.4%) for THY and n = 3469 (18.7%) for BAS. Most adverse drug reactions (ADRs) for THY, BAS, and belatacept affected the adult male population. As expected, the majority of the ADRs were linked to infections, followed by general disorders. BAS presented higher probabilities of drug resistance and transplant rejection being reported among the four molecules. A higher probability of reporting drug ineffectiveness was noted for THY than for the other molecules. Conclusions: All the molecules showed small frequencies regarding resistance. As expected, transplant rejection was more frequently reported for all molecules (especially for BAS), accompanied by a notable variability in reporting frequencies. However, a causal relationship between the reported adverse reactions and drug efficacy cannot be established based on the present results. Further real-world evidence studies will enhance our understanding of the safety and efficacy of these drugs in transplant patients.

Toxoplasma Gondii Replication During Belatacept Treatment in Kidney Transplantation: A Case Report and a Review of the Literature

Belatacept is a chimeric protein that acts as a selective blocker of T-lymphocyte co-stimulation. It has been proposed for the prevention of kidney transplant rejection. This paper reports a literature review on pharmacological characteristics of belatacept and genetic factors influencing its efficacy and safety profile. A severe case of neurotoxoplasmosis observed in a kidney transplant recipient (KTR) treated with belatacept is also described. It appears that the interference of belatacept on guanylate binding proteins (GBPs) expression in antigen-presenting cells (APC) cytoplasm could be involved in Toxoplasma gondii (Toxo-g) reactivation in seropositive KTRs. Additionally, genetic variations in immune regulatory genes encoding CTLA-4 and Blimp-1 may influence individual susceptibility to infection and immune modulation under belatacept therapy. In conclusion, we highlight the importance of drug avoidance and/or increased surveillance in Toxo-g IgG-positive KTR. We also retain that further studies on the host defense pathways involved in the surveillance of opportunistic pathogens in KTR are strongly desirable.