SP728ASSESSING THE ROLE OF BELATACEPT AGAINST TACROLIMUS IN RENAL TRANSPLANTATION

Abstract

INTRODUCTION AND AIMS: Initially, Belatacept a T-cell costimulation blocking agent has been developed as a possible substitute for calcineurin inhibitors, however, recent trials showed no clear evidence against its use over the standard care agent Tacrolimus. The present meta-analysis were done to assess of maintenance immunosuppressive regimens based on belatacept or tacrolimus following renal transplant. METHOD(S): We did Literature search made till 14th December 2017 for randomized control trials (RCTs) comparing the role of belatacept to tacrolimus in renal transplant recipients by searching the PubMed, EMBASE, Cochrane, Crossref, Scopus, clinical trials registry following PROSPERO approval. A random-effects analysis was done to study this meta-analysis. RESULT(S): The literature search identified four randomized prospective studies comparing belatacept with tacrolimus(Fig 1). There was no significant difference in estimated renal function(eGFR) at 12 months(mean difference 4.12 ml/min/1.73m2, CI-2.18 to 10.42, P=0.20).Along with that, belatacept group was associated with significant increase in allograft rejection (RR= 5.12,P = 0.00) and worse allograft survival(RR = 5.77,P = 0.02) CONCLUSION(S): Conclusion(s): The evidence reviewed in this meta-analysis suggest that belatacept-based maintenance immunosuppression regimens were associated with an increased risk allograft loss for renal transplant recipients with equivalent renal functioning when compared to tacrolimus. However, an adaptation of belatacept in renal transplantation has been limited by increased rates of rejection and development resistance owing differentiation into various types of effector memory T cells through, parallel differentiation and immunological synapse with plasticity. This forms T cell lack in membrane expression of CD28 following belatacept treatment, which no longer require co-stimulation and might cross-react with alloantigens. Hence, further studies are required to better elucidate the mechanism of resistance and development of tailored therapeutic strategies involving co-stimulation blockade (Table presented).