Nulojix (belatacept) / BMS - LARVOL DELTA

Belatacept suppresses B-cell subset alloresponses. (PubMed, Hum Immunol) - "At lower C0 levels of < 10 µg/ml, belatacept suppresses alloresponses of B-cells and most B-cell subsets, thereby explaining lower levels of DSA in kidney transplant patients."

Journal • Transplantation • CD27 • CD40LG

COMBAT: The Safety/Efficacy Of Daratumumab With Belatacept In Highly HLA-Sensitized Patients Awaiting Kidney Transplantation (clinicaltrials.gov) - P2 | N=5 | Terminated | Sponsor: University Hospital, Grenoble | Phase classification: P=N/A ➔ P2 | N=12 ➔ 5 | Recruiting ➔ Terminated; limited clinically significant reduction on global cPRA levels (access to transplantation was unchanged), as well as restrictions in belatacept supply.

Enrollment change • Phase classification • Trial termination • Transplantation

Belatacept-Based Immunosuppression and Donor-Specific Antibodies in Lung Transplant: A Multi-Institutional Retrospective Study. (PubMed, Clin Transplant) - "This is the largest cohort to date of LTx patients with DSA who received Belatacept. Belatacept use was associated with a reduction in DSA."

Journal • Retrospective data • Antibody-mediated Rejection • Transplantation

Novel Desensitization Kidney Transplantation (clinicaltrials.gov) - P1/2 | N=5 | Completed | Sponsor: University of Chicago | Recruiting ➔ Completed | Trial completion date: Dec 2026 ➔ Sep 2025 | Trial primary completion date: Sep 2026 ➔ Sep 2025

Trial completion • Trial completion date • Trial primary completion date • Chronic Kidney Disease • Nephrology • Renal Disease • Transplantation

Conversion to belatacept-based immunosuppression as a calcineurin sparing regimen in lung transplant: A multi-institutional retrospective study. (PubMed, Transpl Immunol) - "Belatacept CNI-sparing therapy was well tolerated and feasible in LTx recipients, with renal function appearing to stabilize over time and no apparent safety signal for rejection, infection, malignancy, CLAD, or mortality."

Journal • Retrospective data • Antibody-mediated Rejection • Infectious Disease • Nephrology • Oncology • Respiratory Diseases • Transplantation

Shiga Toxin-Producing Escherichia coli-Associated Hemolytic Uremic Syndrome in Adult Kidney Transplant Recipients. (PubMed, Kidney Int Rep) - "Treatment included azithromycin, eculizumab, and conversion from calcineurin inhibitors (CNIs) to belatacept. This study highlights that STEC-HUS represents a serious complication in KTRs, significantly impairing renal and overall survival. It should be systematically considered in cases of de novo posttransplant TMA, whether in the absence of prodromal diarrhea or in localized intra-renal presentations."

Journal • Acute Kidney Injury • Atypical Hemolytic Uremic Syndrome • Infectious Disease • Nephrology • Transplantation

Co-Stimulatory Blockade Prevents Intragraft Accrual of Class-Switched, Activated B Cells Despite Failing to Prevent T-Cell Mediated Rejection. (PubMed, bioRxiv) - "Here, using single cell RNA sequencing (scRNAseq), we investigated non-CD8 + immune cells during T-cell-mediated rejection (TCMR) under different maintenance immunosuppression (mIS) regimens: tacrolimus, and co-stimulatory blockade (CoB) with belatacept (CTLA4-Ig) or iscalimab (anti-CD40). Notably, cell-cell communication analysis indicated Th17 and Tph cell interactions with B CS cells in tacrolimus, but not CoB, samples. Thus, although failing to prevent TCMR, CoB mIS modulates the accrual of CD4 + T cells and inhibits the intragraft accrual of B CS cells, possibly reflective of clinical observations of less chronic antibody-mediated rejection under CoB mIS."

IO biomarker • Journal • Antibody-mediated Rejection • Transplant Rejection • CD8 • CXCL13 • FOXP3

Development of Atypical Hemolytic Uremic Syndrome After Kidney Transplantation in a Patient with C3 Glomerulopathy (KIDNEY WEEK 2025) - "Following induction with Alemtuzumab and solumedrol, tacrolimus monotherapy was started...On POD4, Eculizumab was started and immunosuppression was changed from tacrolimus to Belatacept and mycophenolic acid...Kidney Found. 2008; 51: 671–677."

Clinical • Anemia • Atypical Hemolytic Uremic Syndrome • Complement-mediated Rare Disorders • Glomerulonephritis • Hematological Disorders • Infectious Disease • Lupus Nephritis • Monoclonal Gammopathy • Nephrology • Thrombocytopenia • Transplantation • CFH • HP

At Last, the Culprit Is Found: Autosomal Dominant Tubulointerstitial Kidney Disease (KIDNEY WEEK 2025) - "He is receiving immunosuppressive medications, including Belatacept, mycophenolate, and prednisone. To improve the comprehension and management of these rare diseases, it is essential to perform randomized controlled trials, which necessitate large cohorts to ensure sufficient statistical power. Nephrologists should conduct more kidney biopsies and genetic tests to better understand these potentially common but underdiagnosed diseases."

Chronic Kidney Disease • Diabetic Nephropathy • Fibrosis • Genetic Disorders • Gout • Immunology • Inflammatory Arthritis • Nephrology • Rare Diseases • Renal Disease • Rheumatology • MUC1 • UMOD

Molecular Diagnostics to Facilitate Belatacept Monotherapy in Kidney Transplant Recipients (KIDNEY WEEK 2025) - P4 | "The most common regimen used with belatacept was prednisone + mycophenolate (n=16). Conclusion The addition of molecular diagnostic biomarkers facilitated the weaning of IS in 50% of subjects with 16.7% successfully achieving belatacept monotherapy. An additional year of monitoring is ongoing to facilitate further immunosuppression weaning."

Clinical • Late-breaking abstract • Monotherapy • Transplantation

Recovery of Prolonged Kidney Allograft Dysfunction Due to Transplant Renal Artery Restenosis Following Stenting: A Case Report (KIDNEY WEEK 2025) - "He was on Tacrolimus, Belatacept and Prednisone. TRAS is a treatable cause of renal allograft dysfunction, which should always be in our list of differentials. Transplant renal artery stent"

Case report • Clinical • Cardiovascular • Nephrology • Transplantation

Progressive Allograft Dysfunction Leading to Rapid Graft Loss in a Kidney Transplant Recipient: A Multifactorial Case of Rejection, Drug Toxicity, and Unexpected Metabolic Injury (KIDNEY WEEK 2025) - "Post-transplant, he developed episodes of acute tubular injury (ATN), borderline T-cell mediated rejection and tacrolimus toxicity, prompting conversion to belatacept...Patients with prior Roux-en-Y gastric bypass are at particularly high risk for enteric hyperoxaluria, a key driver of systemic oxalate burden. This case emphasizes the importance of metabolic evaluation in transplant recipients with history of gastric bypass, beyond immunologic factors to optimize long-term graft survival."

Clinical • Chronic Kidney Disease • Diabetes • Fibrosis • Immunology • Infectious Disease • Inflammation • Metabolic Disorders • Nephrology • Transplantation • Type 2 Diabetes Mellitus

Disseminated Mpox Infection in a Vaccinated Kidney Transplant Recipient (KIDNEY WEEK 2025) - "He was on a belatacept-based immunosuppressive regimen and has received Jynneos approximately two years prior to symptom onset...Given the severity of his lesions, he was treated with IV tecovirimat, vaccinia immune globulin (VIVIg), brincidofovir and topical cidofovir...Additional studies are needed to assess the effectiveness of these vaccines in immunocompromised patients. Figure 1: Perioral lesions before treatment (A) and after treatment ~2 months later (B), abdomen (C), right hand (D), and back lesions with typical desquamation (E)"

Clinical • Chronic Kidney Disease • Human Immunodeficiency Virus • Infectious Disease • Renal Disease • Transplantation

Cytomegalovirus Enteritis in a Kidney Transplant Recipient with Minimal Viremia (KIDNEY WEEK 2025) - "On tacrolimus, mycophenolate, belatacept...He was treated w/ IV Ganciclovir and transitioned to PO valganciclovir...Antiviral therapy is recommended for asymptomatic viremia. A low VL does not rule out localized GI CMV disease."

Clinical • Cytomegalovirus Infection • Focal Segmental Glomerulosclerosis • Gastrointestinal Disorder • Glomerulonephritis • Infectious Disease • Transplantation

A Rare Case of Disseminated Cytomegalovirus Infection in a Late Transplant Recipient Using Belatacept (KIDNEY WEEK 2025) - "She received Basiliximab as induction immunosuppressive and maintenance with Belatacept, mycophenolate mofetil and prednisone...Meropenem was initiated per urine culture with partial relief, prompting cystoscopy...Full dose Valganciclovir was started...Screening is usually limited to the first year post-transplant. This case highlights a severe late-onset CMV infection during a period of low incidence and clinical suspicion."

Clinical • Cytomegalovirus Infection • Fatigue • Genetic Disorders • Hematological Disorders • Infectious Disease • Nephrology • Ocular Inflammation • Ophthalmology • Polycystic Kidney Disease • Retinal Disorders • Solid Organ Transplantation • Transplantation

A LyP on the Lip: A Rare Case of Cutaneous T Cell Lymphomatoid Papulosis (LyP) After Kidney Transplant (KIDNEY WEEK 2025) - "Immunosuppression was modulated to only Belatacept and prednisone...Prompt recognition of LyP and timely adjustment of immunosuppression regimens can help decrease morbidity, limit cytotoxic radiation, and preserve allograft health. (A) Mucosal ulcer (B) Biopsy specimen (H&E) with diffuse pleomorphic lymphoid cells (C) PET-CT of the head and neck with focal avidity pointed by the blue arrows (D) Immunohistochemistry with positive staining for CD2"

Clinical • Chronic Kidney Disease • Cutaneous T-cell Lymphoma • Diabetic Nephropathy • Hematological Malignancies • Lymphoma • Nephrology • T Cell Non-Hodgkin Lymphoma • Transplantation • CD2 • TNFRSF8

Simplified Immunosuppression with Belatacept and Once-Daily Azathioprine and Prednisone in Pediatric Kidney Transplantation (KIDNEY WEEK 2025) - "Before conversion, four were on tacrolimus, one on cyclosporine, three on azathioprine, and two on mycophenolate; all received prednisone...One recipient discontinued belatacept after 11 months due to infusion-related dizziness and post-infusion somnolence; no other adverse effects were observed. Conclusion Belatacept in conjunction with azathioprine and prednisone is a safe and viable option for pediatric kidney transplant recipients with CNI toxicity or non-adherence."

Clinical • Pediatrics • Transplantation

Predicting Risk of Acute Cellular Rejection After Belatacept Conversion (KIDNEY WEEK 2025) - "Key predictors of ACR were shorter time since transplant at belatacept conversion, greater number of HLA mismatches, self-identified Black race, and non-alemtuzumab induction (Table 1, Figure 1a). Conclusion We identified patient factors that predicted ACR risk after belatacept conversion. Future directions include external validation, as well as incorporating the predicted ACR risk of not converting to belatacept, to better inform clinical decision-making."

Cardiovascular

De Novo Belatacept Use in HIV-Positive Kidney Transplant Recipients (KIDNEY WEEK 2025) - "All patients received thymoglobulin 4.5mg/kg for induction, and maintained on mycophenolate mofetil 1000mg twice daily (MMF) prednisone 5 mg daily in addition to belatacept...Compliance with infusion is important for prevention of rejection episodes. Larger studies are needed to corroborate this data"

Clinical • Cardiovascular • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Human Immunodeficiency Virus • Hypertension • Infectious Disease • Metabolic Disorders • Transplantation • CD4

Conversion from Standard Calcineurin Inhibitor-Based Regimen to Noncalcineurin Inhibitor-Based Regimen in Kidney Transplantation: Systematic Review and Network Meta-Analysis (KIDNEY WEEK 2025) - "Conclusion Both sirolimus and belatacept conversion strategies increased rejection risk compared to the standard CNI regimen. However, belatacept was associated with improved graft and patient survival."

Retrospective data • Review • Transplant Rejection • Transplantation

Intravenous Immunoglobulin-Associated Thrombotic Microangiopathy in a Kidney Transplant Recipient (KIDNEY WEEK 2025) - "Immunosuppressive regimen included tacrolimus 0.5mg with belatacept every 8 weeks that was adjusted due to previous recurring infections...Discussion Biopsy findings, exclusion of other etiologies, and favorable response to eculizumab point to IVIG-associated TMA in this case...Prompt recognition of IVIG as a potential trigger for TMA allowed for targeted treatment with complement inhibition. Clinicians should maintain a high index of suspicion when new-onset kidney injury follows recent IVIG administration."

Clinical • Anemia • Antibody-mediated Rejection • Dermatomyositis • Fatigue • Hematological Disorders • Immunology • Infectious Disease • Inflammation • Myositis • Thrombocytopenia • Transplantation • HP

Navigating Therapeutic Challenges: Parvovirus-Induced Pure Red Cell Aplasia in a Kidney Transplant (KT) Recipient Who Declines Blood Transfusions (KIDNEY WEEK 2025) - "Mycophenolate Mofetil (MMF) was stopped, and the due dose of Belatacept was held. She received IVIG 2 g/kg in 2 doses, IV Iron Dextran 1,000 mg, and Epoetin Alfa 40,000 units daily for 2 days, then 10,000 units daily...Compassionate use of hemoglobin-based oxygen carriers should be considered in cases of critical anemia (Hb<4 g/dL). In the absence of antivirals, reducing immunosuppression and providing passive immunity with IVIG can help as seen in this case by a dramatic increase in the R count."

Acute Kidney Injury • Anemia • Antibody-mediated Rejection • Cardiovascular • Chronic Kidney Disease • Gastroenterology • Hematological Disorders • Hypotension • Infectious Disease • Myocardial Ischemia • Nephrology • Renal Disease • Transplantation

Malignancy Risk with Belatacept vs. Calcineurin Inhibitors in Kidney Transplant Recipients: Systematic Review and Meta-Analysis (KIDNEY WEEK 2025) - "Prior CNI exposure significantly modified the effect of belatacept on skin cancer. Clinicians should be aware of the risk of SCs in belatacept conversion."

Retrospective data • Review • Genetic Disorders • Oncology • Skin Cancer • Solid Tumor • Transplantation

Influence of Myeloma Cell Expressed CD28 and CD86 on BCMA CAR T Cell Efficacy and Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS) (ASH 2024) - P2 | "Fifteen patients (65%) received Tocilizumab, and nine patients (39%) received Dexamethasone. These findings, alongside preclinical data indicating CD28-induced proinflammatory cytokine secretion in the myeloma microenvironment, suggest that CD86 on myeloma cells may stimulate CAR T cell toxicity. Future clinical trials should explore CD28 inhibitors (e.g., abatacept, belatacept) to mitigate CRS and ICANS in myeloma patients undergoing CAR T therapy and potentially in those receiving bispecific antibodies."

CAR T-Cell Therapy • Clinical • IO biomarker • Hematological Disorders • Hematological Malignancies • Inflammation • Multiple Myeloma • Oncology • CD28 • CD80 • CD86 • SDC1

Cost-Effectiveness of Belatacept as Conversion Therapy in the Management of Patients Living With a Renal Graft in France (ISPOR-EU 2025) - "Belatacept as conversion therapy for KT rejection prophylaxis is a dominant strategy in the French healthcare context, delivering both cost savings and improved patient outcomes compared to tacrolimus. Delaying graft loss reduces dialysis dependency and postpones re-transplantation, enhancing patient health and economic burden."

Clinical • Cost effectiveness • HEOR