T-cell co-stimulation blocker (CTLA-4 fusion)
Belatacept
Brand names: Nulojix
Adult dose
Dose: 10mg/kg IV days 1, 5, then weeks 2, 4, 8, 12; maintenance 5mg/kg q4w from month 4
Route: IV
Frequency: Variable
Clinical pearls
- KDIGO transplant guidelines: alternative to calcineurin inhibitor maintenance — avoids nephrotoxicity
- Specialist renal transplant centre; EBV serostatus mandatory before initiation
- BTS / NHSBT
Contraindications
- EBV-seronegative recipients (lymphoproliferative disease risk — boxed warning)
- Active infection
- Hypersensitivity
Side effects
- Post-transplant lymphoproliferative disease (especially EBV-naïve)
- CNS PTLD
- Infections (CMV, BK, opportunistic)
- Anaemia
- Diarrhoea
Interactions
- Other immunosuppressives
- Live vaccines
Monitoring
- EBV serology
- Renal graft function
- CMV / BK PCR
- Lymph node assessment
- Mental state
Reference: BNF; KDIGO transplant; BTS/NHSBT; SmPC; https://bnf.nice.org.uk/drugs/belatacept/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- MAGGIC Heart Failure Risk Score · Heart Failure
- Long QT Syndrome (Schwartz Score) · Channelopathy / Sudden Cardiac Death
- C-Peptide to Glucose Ratio · Diabetes Classification
- IMDC (Heng) Score for Metastatic RCC · Renal Cell Carcinoma
- Rome IV Diagnostic Criteria for Faecal Incontinence · Functional GI Disorders
- International Prognostic Index (IPI) for DLBCL · Lymphoma
Pathways
- Hyperkalaemia Management · UK Kidney Association Guidelines 2020; NICE CKD Guidelines
- Rhabdomyolysis · Renal Association 2018; UpToDate 2024
- Hypocalcaemia (Adult) · Society for Endocrinology
- SIADH (Endocrine Perspective) · European Hyponatraemia Guidelines 2014
- Hepatorenal Syndrome · EASL 2018; ICA 2015
- Acute Kidney Injury (AKI) · KDIGO 2012 / NICE AKI 2019