[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Other immunomodulating biologics](https://durgical.com/en/pharmacology/classes/other-immunomodulating-biologics/) › Belatacept

# 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Other immunomodulating biologics](https://durgical.com/en/pharmacology/classes/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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◆**CD80 and CD86 (B7-1 and B7-2) on antigen-presenting cells**Belatacept

ⓘ 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.

**Target in 3D:** CD80 and CD86 (B7-1 and B7-2) on antigen-presenting cells. PDB structure 1I8L (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1I8L) · Drag to rotate · pinch to zoom

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 →](https://durgical.com/en/conditions/kidney-transplant-rejection/)

## Adverse effects

### Common

- Headache, tiredness, weakness
- Pale skin, fast heartbeat
- Swelling of hands, feet or legs
- Constipation

### Serious (rare, important)

- Post-transplant lymphoproliferative disorder (PTLD), mainly in EBV-negative recipients
- Serious infections, including tuberculosis and progressive multifocal leukoencephalopathy
- Skin cancer and other cancers
- Graft loss and death when used in liver transplant

## 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

## Memory aid

BELAtacept: B7 Eclipsed, Liver transplant never, Avoid in EBV-negative (PTLD).

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/belatacept/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Abatacept](https://durgical.com/en/pharmacology/abatacept/)
- [Basiliximab](https://durgical.com/en/pharmacology/basiliximab/)
- [Mycophenolate mofetil](https://durgical.com/en/pharmacology/mycophenolate-mofetil/)

## Related conditions 1

- [Kidney transplant rejection](https://durgical.com/en/conditions/kidney-transplant-rejection/)

[← Back to the class: Other immunomodulating biologics](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a612011.html) (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.](https://www.rcsb.org/structure/1I8L) (RCSB Protein Data Bank, 2001); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L04AA28) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/belatacept/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/belatacept/