Kumar Jayant, Reccia Isabella, Virdis Francesco, Podda Mauro, Sharma Ajay Kumar, Halawa Ahmed
Department of Cancer and Surgery, Imperial College, London W12 0HS, United Kingdom.
Department of Emergency General Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom.
World J Transplant. 2021 Mar 18;11(3):70-86. doi: 10.5500/wjt.v11.i3.70.
The T-cell costimulation blocking agent belatacept has been identified as a possible substitute for calcineurin inhibitors, however, no consensus has been established against its use over the standard care agent Tacrolimus.
To evaluate the effectiveness of belatacept based maintenance immuno-suppressive regimens in comparison to tacrolimus in renal transplantion.
We did extensive search of all the available literature comparing the role of belatacept to tacrolimus in renal transplant recipients by searching the PubMed, Embase, Cochrane, Crossref, Scopus, clinical trials registry on October 5, 2020.
The literature search identified four randomized controlled trials ( = 173 participants) comparing belatacept with tacrolimus. There was no significant difference in estimated renal function at 12 mo [mean difference 4.12 mL/min/1.73 m, confidence interval (CI): -2.18 to 10.42, = 0.20]. Further, belatacept group was associated with significant increase in biopsy proven acute rejection [relative risk (RR) = 3.27, CI: 0.88 to 12.11, = 0.08] and worse 12 mo allograft survival (RR = 4.51, CI: 1.23 to 16.58, = 0.02). However, incidence of new onset diabetes mellitus was lower with belatacept at 12 mo (RR = 0.26, CI: 0.07 to 0.99, = 0.05).
The evidence reviewed in this meta-analysis suggested that belatacept-based maintenance immunosuppression regimens were associated with an increased risk allograft loss in renal transplant recipients with equivalent renal functioning against standard tacrolimus; however, observed significantly reduced new onset diabetes mellitus after transplantation incidence and lower serum low density lipid profile levels in belatacept group. In addition, the adaptation of belatacept in renal transplantation has been forestalled by increased rates of rejection and resistance owing to development of various effector memory T cells through, parallel differentiation and immunological plasticity.
T细胞共刺激阻断剂贝拉西普已被确定为钙调神经磷酸酶抑制剂的一种可能替代物，然而，对于在肾移植中使用贝拉西普优于标准护理药物他克莫司，尚未达成共识。
评估与他克莫司相比，基于贝拉西普的维持免疫抑制方案在肾移植中的有效性。
2020年10月5日，我们通过搜索PubMed、Embase、Cochrane、Crossref、Scopus以及临床试验注册库，广泛检索了所有比较贝拉西普与他克莫司在肾移植受者中作用的现有文献。
文献检索确定了四项比较贝拉西普与他克莫司的随机对照试验（n = 173名参与者）。12个月时估计肾功能无显著差异[平均差异4.12 mL/min/1.73 m²，置信区间（CI）：-2.18至10.42，P = 0.20]。此外，贝拉西普组活检证实的急性排斥反应显著增加[相对风险（RR）= 3.27，CI：0.88至12.11，P = 0.08]，且12个月时移植肾存活率更低（RR = 4.51，CI：1.23至16.58，P = 0.02）。然而，12个月时贝拉西普组新发糖尿病的发生率较低（RR = 0.26，CI：0.07至0.99，P = 0.05）。
该荟萃分析中所回顾的证据表明，与标准他克莫司相比，在肾功能相当的肾移植受者中，基于贝拉西普的维持免疫抑制方案与移植肾丢失风险增加相关；然而，观察到贝拉西普组移植后新发糖尿病的发生率显著降低，且血清低密度脂蛋白水平更低。此外，由于通过平行分化和免疫可塑性产生了各种效应记忆T细胞，导致排斥反应和耐药率增加，阻碍了贝拉西普在肾移植中的应用。
