What is Belatacept and is it going to change the face of transplantation? Its a fusion protein composed of components of TLA-4, extracellular domain of IgG1. The drug can selectively block the T cell activation by inhibiting this costimulatory molecule CTLA-4. From the researchers mainly at UCSF, a landmark paper was published few years ago in NEJM.
They assigned renal tranplant patients to receive an intensive or less intensive of belatacept or cyclosporine. All patients were induced with the same agent of basiliximab. All received steroids and MMF. At six months, they evaluated that the incidence of acute rejection was no different in two groups. CAN, and decrease in GFR was less common in the belatacept arm.
This drug might show promise. Lets see once more widespread use of it is noted. It might allow us to spare cyclosporine or tacrolimus use in many of our patients. This is important as one of the most common causes of graft loss these days is not rejection but chronic calcineurin toxicity or chronic changes due to medications. The effect on the pancreas by these drugs is also not benign and the most common glomerular disease post transplant still remains to be diabetes.
Lets await and see.
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