Belatacept Use and Risk of Post-Transplant Lymphoproliferative Disorder in Kidney Transplant Recipients

Introduction

Belatacept, a fusion protein inhibiting T-cell activation, has shown benefits in kidney function and reduced risk of graft loss or death compared to CNI-based immunosuppression. However, its use is associated with a risk of PTLD, a severe complication post-transplantation.

Methods

This retrospective observational study analyzed data from the Organ Procurement and Transplantation Network (OPTN) database, focusing on adult, EBV-seropositive, kidney-only transplant recipients who received belatacept or CNI between June 15, 2011, and June 14, 2016.

Results

Among 1737 belatacept-treated and 74,637 CNI-treated patients, 1631 and 59,992 were EBV-seropositive, respectively. The study found nine PTLD events in the belatacept group and 204 in the CNI group within five years post-transplant. The Kaplan–Meier incidence rates of PTLD increased over time in both groups, with no significant difference between them.

Discussion

The analysis indicates that belatacept is largely used in accordance with its approved labeling among EBV-seropositive kidney transplant recipients. The risk of PTLD remains low and comparable to that observed with CNI-based immunosuppression. However, the study acknowledges limitations inherent to retrospective observational studies, including potential underreporting of PTLD and the need for future research to assess longer-term risks.

Conclusion

Belatacept use in routine clinical practice among EBV-seropositive kidney transplant recipients is associated with a low risk of PTLD, similar to that seen with CNI-based immunosuppression. The findings support the continued use of belatacept in this patient population, with attention to monitoring for PTLD.