Belatacept
Other immunomodulating biologics
Other immunomodulating biologics
A CTLA-4–Ig fusion protein infused monthly to prevent kidney transplant rejection, sparing calcineurin-inhibitor toxicity; only for EBV-positive recipients.
Quick facts
- Group
- Other immunomodulating biologics
- Target
- CD80 and CD86 (B7-1 and B7-2) on antigen-presenting cells
- Key effects
- Headache · Pale skin · Swelling of hands
- Monitor
- EBV and CMV status before starting
- ATC
- L04AA28
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows human CTLA-4 bound to B7-1 (CD80); belatacept carries a modified version of this CTLA-4 binding domain, fused to an IgG1 Fc.
Belatacept is a second-generation CTLA-4–Ig: the extracellular part of CTLA-4, with two amino-acid changes that raise its affinity for CD80 and CD86, fused to a modified human IgG1 Fc. It coats CD80 and CD86 on antigen-presenting cells so they cannot engage CD28 on T cells. Without this second (costimulatory) signal, T cells become anergic or die and the graft is not attacked.
- Fusion protein binds CD80 and CD86 on antigen-presenting cells
- CD28 on T cells gets no costimulatory signal
- T cells become anergic instead of activated
- Kidney graft rejection is prevented
Indications
- Prevention of kidney transplant rejection in adults, with basiliximab induction, mycophenolate and corticosteroids Kidney transplant rejection →
Adverse effects
Common
- Headache, tiredness, weakness
- Pale skin, fast heartbeat
- Swelling of hands, feet or legs
- Constipation
Contraindications
- Recipients who are EBV-seronegative or whose EBV status is unknown
- Liver transplant
- Hypersensitivity to belatacept
Key interactions
- Other treatments that deplete T cells (such as anti-thymocyte globulin)
- Higher risk of PTLD.
- Vaccines, especially live vaccines
- Avoided during treatment unless the transplant team agrees.
What is monitored
- EBV and CMV status before starting
- New neurological symptoms (confusion, weakness, vision or speech changes)
- Skin lesions and swollen lymph nodes
- Kidney function and signs of rejection
Administration and safety
- Given only in a facility by staff experienced in kidney transplant care.
- Intravenous infusion over a short time.
- Used together with other immunosuppressants, never alone.
Pregnancy and breastfeeding
Human data are limited; pregnancy and breastfeeding are discussed with the transplant team.
Nursing care
- Confirm a positive EBV result before the first infusion.
- Teach to report confusion, memory or speech changes, weakness, vision changes, swollen glands or weight loss.
- Teach sun protection and skin self-checks.
- Teach to report fever, cough or other signs of infection.
Pharmacokinetics
- Absorption
- Intravenous infusion in a medical facility
- Half-life
- About 11 days, so infusions become monthly after the first months
Test yourself
Think of the answer, then tap the question to see it.
Which molecules does belatacept bind?
CD80 and CD86 (B7-1 and B7-2) on antigen-presenting cells.
Why is belatacept given only to EBV-seropositive recipients?
EBV-negative recipients have a higher risk of post-transplant lymphoproliferative disorder.
In which transplant is belatacept not used?
Liver transplant: it was linked to graft loss and death.
Connections
← Back to the class: Other immunomodulating biologics
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Belatacept Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2012); RCSB PDB - 1I8L: Crystal structure of the B7-1/CTLA-4 complex that inhibits human immune responses. (RCSB Protein Data Bank, 2001); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.