Purpose of review: Long-term side effects of posttransplant immunosuppressive agents contribute to graft loss and death. This article reviews recent publications on the potential role of costimulation targeting therapies, especially belatacept, in solid organ transplantation.
Recent findings: Belatacept, currently undergoing phase III clinical trials in renal transplantation, has shown promise as a safe and effective alternative immunosuppression regimen to calcineurin inhibitor and steroid-based therapies. Phase II trials demonstrated similar efficacy to cyclosporine, with greatly improved renal function. Although its side effects are not yet well characterized, belatacept has shown a decrease of the renal, cardiovascular, and metabolic side effects associated with calcineurin inhibitors.
Summary: Belatacept appears to be a safe and effective alternative to calcineurin inhibitor and steroid-based immunosuppressive strategies. Using belatacept in combination with another agent that blocks a different costimulatory pathway has proved especially effective. The results of ongoing and future phase III trials will be needed to validate current findings and determine the most effective belatacept-based regimen for patient populations.