Open AccessDoes belatacept improve outcomes for kidney transplant recipients? A systematic review
Author(s) -
Talawila Nishanthi,
Pengel Liset H. M.
Publication year - 2015
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12605
Subject(s) - belatacept , medicine , renal function , urology , abatacept , calcineurin , odds ratio , kidney transplantation , randomized controlled trial , transplantation , kidney transplant , rituximab , lymphoma
Summary 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 ( RCT s) in adult KT comparing belatacept with CNI s. Methodological quality was assessed. Meta‐analyses were performed to calculate odds ratios ( OR ) and mean differences ( MD ). Results Six RCT s 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. Conclusion 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.