Real-world Evidence Regarding Cancer, Mortality, and Graft Failure Risk With de Novo Belatacept Use Among Kidney Transplant Recipients in the United States.

Details

• Alternative Title:
  American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2025, v. 25, no. 8: Real-world Evidence Regarding Cancer, Mortality, and Graft Failure Risk With de Novo Belatacept Use Among Kidney Transplant Recipients in the United States.
• Journal Article:
  American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
• Personal Author:
  Ahmed, Shyfuddin ; Pfeiffer, Ruth M ; Volesky-Avellaneda, Karena ; Blosser, Christopher D ; Snyder, Jon J ; Israni, Ajay K ; Lynch, Charles F ; Qiao, Baozhen ; Rees, Judy R ; Zwald, Fiona ; Yu, Kelly J ; Engels, Eric A.
• Description:
  Belatacept is a selective T cell costimulation blocker used in maintenance immunosuppression for kidney transplant recipients (KTRs), but evidence on cancer risk and other outcomes is limited. This retrospective cohort study used linked US transplant and cancer registry data on KTRs treated with belatacept (N = 1514) or tacrolimus (N = 7570) as initial maintenance therapy. We used multivariable Cox regression models to compare the incidence of invasive cancer, cutaneous squamous cell carcinoma, posttransplant lymphoproliferative disorder (PTLD), death, and graft failure/retransplantation (GF/RT) between belatacept and tacrolimus users. Overall, cancer incidence was 10.1 and 12.6 per 1000 person-years in belatacept and tacrolimus users, respectively. We did not find increased risk with belatacept for cancer overall (adjusted hazard ratio HR, 0.83; 95% confidence interval CI, 0.53-1.30), individual cancer types, or cutaneous squamous cell carcinoma. Belatacept was associated with increased risk of death (adjusted HR, 1.22; 95% CI, 1.04-1.43) but lower risk of GF/RT >4 years after transplantation (adjusted HR, 0.54; 95% CI, 0.35-0.83). PTLD risk was increased among Epstein-Barr virus-seropositive KTRs (adjusted HR, 1.96; 95% CI, 1.03-3.73). This study provides reassurance that belatacept does not increase cancer risk among KTRs, and there was a long-term protective association for GF/RT. However, we found evidence suggesting a potentially increased risk of PTLD and death with belatacept use.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Kidney Transplantation
  • Abatacept
  • Male
  • Female
  • Retrospective Studies
  • Middle Aged
  • Graft Rejection
  • Immunosuppressive Agents
  • Neoplasms
  More +
• Keywords:
  • kidney transplantation
  • belatacept
  • cancer
  • mortality
  • Epstein-Barr virus
  • squamous cell carcinoma
  • posttransplant lymphoproliferative disorders
• Source:
  American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2025, v. 25, no. 8
• DOI:
  https://doi.org/10.1016/j.ajt.2025.03.004
• ISSN:
  1600-6135 ; 1600-6143
• Pubmed ID:
  40064297
• Pubmed Central ID:
  PMC12310376
• Document Type:
  Text
• Funding:
  27307C0011/ES/NIEHS NIH HHSUnited States/ ; HHSN261201000036C/CA/NCI NIH HHSUnited States/ ; HHSN261201800013C/CA/NCI NIH HHSUnited States/ ; N01 PC035137/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; Z99 CA999999/ImNIH/Intramural NIH HHSUnited States/ ; 75N92021D00009/HL/NHLBI NIH HHSUnited States/ ; HHSN261201800012I/CA/NCI NIH HHSUnited States/ ; HHSN261201800002B/CA/NCI NIH HHSUnited States/ ; 75N98021D00006/OD/NIH HHSUnited States/ ; HHSN261201000037C/CA/NCI NIH HHSUnited States/ ; 27305C0011/ES/NIEHS NIH HHSUnited States/ ; 75N96021D00006/ES/NIEHS NIH HHSUnited States/ ; HHSN261201800004C/CA/NCI NIH HHSUnited States/ ; N01 PC035143/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; U58 DP003875/DP/NCCDPHP CDC HHSUnited States/ ; 75N97021D00006/LM/NLM NIH HHSUnited States/ ; HHSN261201800014C/CA/NCI NIH HHSUnited States/ ; HHSN261201800016C/CA/NCI NIH HHSUnited States/ ; N01 PC035139/CA/NCI NIH HHSUnited States/ ; 75N99021D00009/OF/ORFDO NIH HHSUnited States/ ; U58 DP000807/DP/NCCDPHP CDC HHSUnited States/ ; NU58DP007160/DP/NCCDPHP CDC HHSUnited States/ ; 27398C0011/ES/NIEHS NIH HHSUnited States/ ; HHSN261201800016I/CA/NCI NIH HHSUnited States/ ; U58 DP003933/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP000848/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201800012C/CA/NCI NIH HHSUnited States/ ; 75N90021D00009/CL/CLC NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003921/DP/NCCDPHP CDC HHSUnited States/ ; 75N92021D00006/HL/NHLBI NIH HHSUnited States/ ; HHSN261201800014I/CA/NCI NIH HHSUnited States/ ; 75N96021D00009/ES/NIEHS NIH HHSUnited States/ ; HHSN261201800002C/CA/NCI NIH HHSUnited States/ ; HHSN261201800013I/CA/NCI NIH HHSUnited States/ ; HHSN261201800006I/CA/NCI NIH HHSUnited States/ ; U58 DP000824/DP/NCCDPHP CDC HHSUnited States/
• Genre:
  Journal Article
• Place as Subject:
  United States
• Pages in Document:
  1723-1734 (23 pdf pages)
• Volume:
  25
• Issue:
  8
• Download URL:
  https://stacks.cdc.gov/view/cdc/261612/cdc_261612_DS1.pdf
• File Type:
  [PDF - 1022.08 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:21d02bf269f2a553cf176da4f828ab6345e03545ccedf3ede9e8ade7775642bc153e955bc1c0c27e811482d53c4e7b5f9b8b86c5c9478ea4dfae78b1a8d45bf0