Belatacept

How it works

It is a selective T-cell co-stimulation blocker that binds CD80 and CD86 on antigen-presenting cells, preventing the CD28 co-stimulatory signal required for full T-cell activation.

Prescribing in practice

• It must only be used in patients who are Epstein-Barr virus seropositive, because EBV-seronegative recipients have a markedly increased risk of post-transplant lymphoproliferative disorder, predominantly affecting the central nervous system.
• There is an increased risk of serious infections, including progressive multifocal leukoencephalopathy.
• It is given by intravenous infusion as part of a regimen with other immunosuppressants.

Monitoring

Monitor for signs of infection, neurological symptoms and features suggestive of lymphoproliferative disease, alongside graft function.

Counselling the patient

• Report new or worsening neurological symptoms such as confusion, weakness or vision changes promptly.
• Report any signs of infection without delay.
• Attend all scheduled infusions and clinic appointments.

Evidence & guidelines

Belatacept is licensed for kidney transplant rejection prophylaxis restricted to EBV-seropositive recipients owing to lymphoproliferative risk.