Belatacept Use after Kidney Transplantation and Its Effects on Risk of Infection and COVID-19 Vaccine Response

Introduction: Belatacept is a common immunosuppressive therapy used after kidney transplantation (KT) to avoid calcineurin-inhibitor (CNI) use and its related toxicities. It is unclear whether its use exposes KT recipients (KTx) to a greater risk of infection or a poorer response to vaccines. Areas...

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Autores principales:	Florian Terrec, Thomas Jouve, Paolo Malvezzi, Bénédicte Janbon, Hamza Naciri Bennani, Lionel Rostaing, Johan Noble
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	kidney transplantation immunosuppressive regimen opportunistic infections belatacept cytomegalovirus CD80/CD86 Medicine R
Acceso en línea:	https://doaj.org/article/eb431271e3ad4a509ba6947235bfe241
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spelling	oai:doaj.org-article:eb431271e3ad4a509ba6947235bfe2412021-11-11T17:46:36ZBelatacept Use after Kidney Transplantation and Its Effects on Risk of Infection and COVID-19 Vaccine Response10.3390/jcm102151592077-0383https://doaj.org/article/eb431271e3ad4a509ba6947235bfe2412021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/5159https://doaj.org/toc/2077-0383Introduction: Belatacept is a common immunosuppressive therapy used after kidney transplantation (KT) to avoid calcineurin-inhibitor (CNI) use and its related toxicities. It is unclear whether its use exposes KT recipients (KTx) to a greater risk of infection or a poorer response to vaccines. Areas covered: We reviewed PubMed and the Cochrane database. We then summarized the mechanisms and impacts of belatacept use on the risk of infection, particularly opportunistic, in two settings, i.e., de novo KTx and conversion from CNIs. We also focused on COVID-19 infection risk and response to SARS-CoV-2 vaccination in patients whose maintenance immunosuppression relies on belatacept. Expert opinion: When belatacept is used de novo, or after drug conversion the safety profile regarding the risk of infection remains good. However, there is an increased risk of opportunistic infections, mainly CMV disease and Pneumocystis pneumonia, particularly in those with a low eGFR, in older people, in those receiving steroid-based therapy, or those that have an early conversion from CNI to belatacept (i.e., <six months post-transplantation). Thus, we recommend, if possible, delaying conversion from CNI to belatacept until at least six months post-transplantation. Optimal timing seems to be eight months post-transplantation. In addition, KTx receiving belatacept respond poorly to SARS-CoV-2 vaccination.Florian TerrecThomas JouvePaolo MalvezziBénédicte JanbonHamza Naciri BennaniLionel RostaingJohan NobleMDPI AGarticlekidney transplantationimmunosuppressive regimenopportunistic infectionsbelataceptcytomegalovirusCD80/CD86MedicineRENJournal of Clinical Medicine, Vol 10, Iss 5159, p 5159 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	kidney transplantation immunosuppressive regimen opportunistic infections belatacept cytomegalovirus CD80/CD86 Medicine R
spellingShingle	kidney transplantation immunosuppressive regimen opportunistic infections belatacept cytomegalovirus CD80/CD86 Medicine R Florian Terrec Thomas Jouve Paolo Malvezzi Bénédicte Janbon Hamza Naciri Bennani Lionel Rostaing Johan Noble Belatacept Use after Kidney Transplantation and Its Effects on Risk of Infection and COVID-19 Vaccine Response
description	Introduction: Belatacept is a common immunosuppressive therapy used after kidney transplantation (KT) to avoid calcineurin-inhibitor (CNI) use and its related toxicities. It is unclear whether its use exposes KT recipients (KTx) to a greater risk of infection or a poorer response to vaccines. Areas covered: We reviewed PubMed and the Cochrane database. We then summarized the mechanisms and impacts of belatacept use on the risk of infection, particularly opportunistic, in two settings, i.e., de novo KTx and conversion from CNIs. We also focused on COVID-19 infection risk and response to SARS-CoV-2 vaccination in patients whose maintenance immunosuppression relies on belatacept. Expert opinion: When belatacept is used de novo, or after drug conversion the safety profile regarding the risk of infection remains good. However, there is an increased risk of opportunistic infections, mainly CMV disease and Pneumocystis pneumonia, particularly in those with a low eGFR, in older people, in those receiving steroid-based therapy, or those that have an early conversion from CNI to belatacept (i.e., <six months post-transplantation). Thus, we recommend, if possible, delaying conversion from CNI to belatacept until at least six months post-transplantation. Optimal timing seems to be eight months post-transplantation. In addition, KTx receiving belatacept respond poorly to SARS-CoV-2 vaccination.
format	article
author	Florian Terrec Thomas Jouve Paolo Malvezzi Bénédicte Janbon Hamza Naciri Bennani Lionel Rostaing Johan Noble
author_facet	Florian Terrec Thomas Jouve Paolo Malvezzi Bénédicte Janbon Hamza Naciri Bennani Lionel Rostaing Johan Noble
author_sort	Florian Terrec
title	Belatacept Use after Kidney Transplantation and Its Effects on Risk of Infection and COVID-19 Vaccine Response
title_short	Belatacept Use after Kidney Transplantation and Its Effects on Risk of Infection and COVID-19 Vaccine Response
title_full	Belatacept Use after Kidney Transplantation and Its Effects on Risk of Infection and COVID-19 Vaccine Response
title_fullStr	Belatacept Use after Kidney Transplantation and Its Effects on Risk of Infection and COVID-19 Vaccine Response
title_full_unstemmed	Belatacept Use after Kidney Transplantation and Its Effects on Risk of Infection and COVID-19 Vaccine Response
title_sort	belatacept use after kidney transplantation and its effects on risk of infection and covid-19 vaccine response
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/eb431271e3ad4a509ba6947235bfe241
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Belatacept Use after Kidney Transplantation and Its Effects on Risk of Infection and COVID-19 Vaccine Response

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