Costimulatory blockade with belatacept in clinical and experimental transplantation - a review

Expert Opin Biol Ther. 2009 Jun;9(6):789-96. doi: 10.1517/14712590902942284.


Background: Current maintenance immunosuppression agents have been critical to the improved graft and patient survival rates in solid organ transplantation observed over the past decade. However, long-term follow-up has revealed that these agents are associated with troublesome side effects and chronic toxicity, contributing to graft loss and death.

Objectives: Costimulation blockade has long been recognized as an important target for immunomodulation in solid organ transplantation. Belatacept, a high-affinity chimeric fusion protein that binds to CD80/CD86 on antigen-presenting cells, has shown great promise in renal transplantation and is now in Phase III trials.

Methods: This review explores the development and efficacy of belatacept, compared with currently approved immunosuppressive agents used in transplantation.

Results: Belatacept seems to be an effective alternative to current maintenance immunosuppressive therapies, with no apparent end organ toxicity and a minimal side-effect profile. This agent works best when used in combination with therapies that target different pathways of T-cell activation, but the optimal regimen has not yet been identified. Data generated in ongoing clinical trials will be essential in validating previous studies and for further development of belatacept-based combinatorial strategies.

Publication types

  • Review

MeSH terms

  • Abatacept
  • Animals
  • Contraindications
  • Humans
  • Immunoconjugates / adverse effects
  • Immunoconjugates / therapeutic use*
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Transplantation*


  • Immunoconjugates
  • Immunosuppressive Agents
  • Abatacept