Belatacept Transplant Drug Offers Hope for Preserving Kidney Function

Today, kidney transplantation provides patients with invaluable benefits—it prolongs lifespan and restores vitality and health. However, this hasn’t always been the case. As recently as the 1980s, results of transplants were fairly poor, and kidneys were often lost from rejection. In 1983, the cyclosporine class of drugs entered the equation, revolutionizing transplantation. Short-term outcomes improved greatly, and we expected most of our patients to survive with a functioning graft—90% of them at the 1-year mark.

Unfortunately, while cyclosporine is ideal for short-term outcomes, it causes many side effects that affect long-term outcomes in patients. Cyclosporine is toxic to the kidney—over time, this causes excess scarring and eventually even leads to loss of kidney function.

In approximately one-third of patients, cyclosporine causes post-transplant diabetes, requiring most patients to take blood pressure lowering medications. Additionally, most must take medications to lower their cholesterol. (High blood pressure and increased cholesterol counts are both side effects of cyclosporine.) Ultimately, patients must take the anti-rejection drugs along with a host of other drugs to combat the side effects, all of which can lead to death from cardiovascular disease. On average, the kidney transplant patient survival rate is only 8-10 yrs, which is clearly short of what we’d like to see.

Sufficed to say, there’s been a tremendous need for better drugs to prevent rejection in kidney transplants, without causing life-threatening side effects.

Introducing Belatacept

When kidney patients suffer from transplant rejection, the immune system essentially recognizes the new kidney as a foreign object, causing lymphocytes and T-cells to attack, and generating immune damage to the transplant. Consequently, we introduce drugs to dampen the immune system. The issue with cyclosporine is that it doesn’t just affect the immune response; it hits several other targets throughout the body, causing the negative side effects. Fortunately, there’s hope on the horizon with a newer drug called belatacept.

Like Cyclosporine, belatacept blocks the immune system from transplant rejection. However, the target of belatacept is only expressed in the immune system, so it suppresses undesired immune responses of rejection without the off target side effects (e.g. high blood pressure, increased cholesterol and diabetes) seen with Cyclosporine. We refer to these off-target responses as “costimulatory signals”.

In transplantation, our goal is to achieve a normal life span for our patients, and to ideally have them move on from surgery dialysis-free. At Emory, we’ve dedicated years to developing new and improved therapies that avoid major complications from kidney transplants, including cardiovascular issues, infections and malignancies.

Recent belatacept studies indicate that this drug could quite possibly help us in achieving these goals. Over 1400 patients have been studied with belatacept’s use in kidney transplant, and the results continue to be extremely promising. Further, the drug could conceivably have advantages for other types of organ transplantation, including liver, heart, lung, and intestinal.

Do you have any questions about belatacept, or about kidney transplantation in general? If so, please let me know in the comments.

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7 Responses to “Belatacept Transplant Drug Offers Hope for Preserving Kidney Function”

  1. Linda F. says:

    I have had a third kidney transplant and take prograf and myfortic with prednisone. Can I take
    this belatacept? My first two kidneys rejected. I have hernia now and need some surgery.

    • Dr. Christian P. Larsen, MD, DPhil says:

      Hi Linda. Research has shown that the greatest benefit is yielded from Belatacept when it’s use is begun at the time of transplant. To date, the drug has not yet been approved by the FDA as an immunosuppressive agent in kidney transplantation, and is still in the research phase. Once it is approved, your transplant physician could elect to incorporate Belatacept as a component of your immunosuppressive strategy dependent upon your specific clinical situation.

  2. Gaynor says:

    Has there been any studies on the effect of Belatacept on an ESRD patient with lupus? Patient recently began the transplant process at Emory. Patient was diagnosed with ESRD caused by lupus and high blood pressure 3 years ago.
    As an immunosuppressive agent, one would expect a positive effect, with regards to lupus.

    • Allan Kirk, M.D., Ph.D, Professor and Scientific Director, Emory Transplant Center says:

      Gaynor,

      Belatacept has been used in patients receiving transplants who have lupus, and one could anticipate that it would be helpful. However, I am not aware of specific trials demonstrating that.

      Thanks for the question,
      Dr. Allan Kirk

  3. Cynthia says:

    I have been made aware that a 2nd transplant could be in my future. Are there any clinical trials being held at Emory for belatecept?

    • Moderator says:

      Comment modified to protect patient privacy.

    • Allan Kirk, M.D., Ph.D, Professor and Scientific Director, Emory Transplant Center says:

      Cynthia,

      At present, there are no trials enrolling re-transplant patients for belatacept. However, there are plans for using belatacept in selected re-transplant patients in the next year. Use of belatacept will depend in large part on the FDA approval of the drug anticipated in the next 6 months.

      Thanks,
      Dr. Kirk