Belatacept is a novel agent that prevents CD28 signaling and inhibits T-cell activation by costimulation blockade. It was developed from abatacept (CTLA-4 Ig), the first recombinant immunoglobulin fusion protein that contains extracellular portion of CTLA-4, and the Fc domain of IgG. Early studies have shown that belatacept recipients show comparable patient and graft survival, superior renal function and renal biopsy data compared with cyclo-sporine- treated patients. Newer biologic agents such as belatacept offer the promise of real change-due to their lack of mechanism-related toxic effects-and help monitor drug administration, thereby improving compliance. Belatacept is a potential option for maintenance biologic therapy without a calcineurin inhibitor, accompanied by excellent mid-term results with yet unknown long-term safety and efficacy. The increased rate of TCMR and possibly central nervous system post-transplantation lymphoproliferative disorder are worrisome and need to be further elucidated.
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