Belatacept during pregnancy in renal transplant recipients: Two case reports

Am J Transplant. 2018 Aug;18(8):2079-2082. doi: 10.1111/ajt.14911. Epub 2018 Jun 3.


Impaired fertility is common among patients with chronic organ failure, including end-stage renal disease (ESRD). Women of childbearing age undergoing transplantation may experience rapid return of fertility. Pregnancy posttransplant presents numerous risks for the patient, fetus, and allograft. Maternal risks include hypertension and preeclampsia. Allograft risks include acute rejection and failure of the organ, and fetal risks include miscarriage, birth defects from immunosuppressants, premature delivery, and low birth weight. Belatacept, a selective T cell costimulation blocker, was approved for use in kidney transplant recipients in the United States in 2011. Little is known about the safety of belatacept during pregnancy in humans. We describe 2 cases of successful pregnancy and delivery with the use of belatacept-based immunosuppression. The Transplant Pregnancy Registry International (TPR) is a voluntary registry for transplant recipients who have had pregnancies or fathered a pregnancy posttransplant. To date, these 2 cases are the only known exposures to belatacept that have been reported to the TPR.

Keywords: clinical research/practice; immunosuppressant - fusion proteins and monoclonal antibodies: belatacept; immunosuppression/immune modulation; kidney (allograft) function/dysfunction; kidney disease; kidney transplantation/nephrology; obstetrics and gynecology; pregnancy.

Publication types

  • Case Reports

MeSH terms

  • Abatacept / therapeutic use*
  • Adult
  • Female
  • Gestational Age
  • Glomerular Filtration Rate
  • Graft Rejection / drug therapy*
  • Graft Rejection / etiology
  • Graft Survival / drug effects*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infant, Newborn
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / adverse effects*
  • Pregnancy
  • Pregnancy Outcome
  • Transplant Recipients


  • Immunosuppressive Agents
  • Abatacept