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Costimulation Blockade in Kidney Transplant Recipients
Marieke van der Zwan1,2,3, Dennis A Hesselink4,5, Martijn W F van den Hoogen4,5
1Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. m.vanderzwan@erasmusmc.nl.
Drugs
|November 22, 2019
Summary
Costimulation blockade therapies target immune responses after kidney transplants. Belatacept is approved but carries risks, prompting a review of current and developing options for kidney transplant indications.
Area of Science:
- Immunology
- Transplantation Medicine
- Pharmacology
Background:
- T cell-antigen-presenting cell costimulation is crucial for alloimmune responses post-kidney transplant.
- Conventional immunosuppression does not target this costimulation.
- Costimulation blockade offers targeted immune modulation with fewer non-immune adverse events.
Purpose of the Study:
- To review current and emerging costimulation blockade therapies for kidney transplant recipients.
- To provide an overview of therapeutic strategies targeting immune regulation in transplantation.
Main Methods:
- Literature review of costimulation blockade therapies in kidney transplantation.
- Analysis of approved and investigational agents targeting T cell costimulatory pathways.
Main Results:
- Belatacept selectively targets the CD28-CD80/CD86 pathway and is the only approved costimulation blockade for kidney transplants.
- Belatacept shows promise in specific patient subgroups but is associated with increased acute rejection risk.
- Various other costimulation blockade approaches have been explored with mixed success.
Conclusions:
- Costimulation blockade represents a significant advancement in kidney transplant immunosuppression.
- Careful patient selection and monitoring are essential for therapies like belatacept.
- Ongoing research aims to optimize costimulation blockade for improved transplant outcomes.
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