Renal Transplantation Using Belatacept Without Maintenance Steroids or Calcineurin Inhibitors

The belatacept-sirolimus regimen with alemtuzumab induction successfully prevented clinical biopsy-proven acute rejection in all 20 live donor kidney transplant recipients within the first year, with

Effect: improvement; 0/20 clinical acute rejections in first year

Seven of 10 kidney transplant recipients who attempted weaning from oral immunosuppression were successfully maintained rejection-free on belatacept monotherapy alone, with stable excellent graft func

Effect: improvement; 7/10 patients weaned to belatacept monotherapy successfully

Donor bone marrow infusion did not significantly improve rejection prevention when added to the belatacept-sirolimus regimen, with all three episodes of subclinical rejection occurring in patients who

Effect: null; P=0.22 (Fisher's exact test)

Half of the transplant recipients on the belatacept-sirolimus regimen developed transient BK viremia within the first year, suggesting disproportionate impairment of anti-BK virus immunity, although a

Effect: adverse; 10/20 patients (50%) developed transient BK viremia

The alemtuzumab-belatacept-sirolimus regimen promoted repopulation of a lymphocyte repertoire enriched for naive CD28+ T and B cells and depleted of differentiated CD28-negative effectors, with increa

Effect: improvement