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Abstract: TH-PO832

Safety of Belatacept as a Maintenance Immunosuppressive Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Tawhari, Ibrahim, King Khalid University, Abha, Asir, Saudi Arabia

Although calcineurin inhibitors (CNIs) are used as the standard maintenance immunosuppressive therapy after kidney transplantation, they are associated with nephrotoxicity and long-term renal allograft loss. Recent randomized controlled trials (RCTs) showed that using Belatacept (Bela) as an alternative to CNIs is associated with improves renal functions. However, there has been conflicting data about the risk of adverse outcomes such as infections and malignancies.


A systematic search for RCTs assessing the safety and efficacy of Bela in adult kidney transplant recipients was conducted in multiple online databases including Google Scholar and PubMed. RStudio was used for statistical analysis. Results are expressed as relative risk ratio (RR) and 95% confidence interval (CI).


Five RCTs were included in our meta-analysis. The results showed no significant difference between the Bela and CNIs based-regimen in terms of renal allograft loss (RR= 0.77, 95% CI 0.52 – 1.09), cytomegalovirus (CMV) viremia (RR= 0.0.98, 95% CI 0.47 – 1.30), BK viremia (RR= 0.83, 95% CI 0.35 – 2.02), and malignancy (RR= 1.31, 95% CI 0.81 – 2.13). There was a significant increase in the risk of post-transplant lymphoproliferative disorder (PTLD) (RR= 3.87, 95% CI 1.08 – 13.82), but the majority of those patients were Epstein-Barr virus (EBV) seronegative.


Overall, the use of Bela as maintenance immunosuppressive therapy in kidney transplantation was generally safe and with no substantial increase in the risk of infection or malignancy. There was an increased risk of PTLD associated with this regimen in patients with EBV-negative serology. Avoiding Bela in EBV-negative patients may help lower this risk.