Twenty years of research and you start to improve outcomes for transplant patients.
The Nature paper from Chris Larsen and Tom Pearson on “costimulation blockers” and their ability to head off graft rejection in rodents first appeared in 1996.
Almost 20 years later, a seven-year study of kidney transplant recipients has shown that the drug belatacept, a costimulation blocker based on Larsen and Pearson’s research, has a better record of patient and organ survival than a calcineurin inhibitor, previously the standard of care.
Kidney transplant recipients need to take drugs to prevent their immune systems from rejecting their new organs, but the drugs themselves can cause problems. Long-term use of calcineurin inhibitors, such as tacrolimus, can damage the transplanted kidneys and lead to cardiovascular disease and diabetes.
In the accompanying video, Larsen -Â now dean of Emory University School of Medicine – and Pearson -Â executive director of Emory Transplant Center – explain.
Belatacept was approved by the FDA in 2011 and is produced by Bristol Myers Squibb. Results from the BENEFIT study of belatacept, led by Larsen and UCSF transplant specialist Flavio Vincenti, were published in the Jan. 28 issue of the New England Journal of Medicine.
To go with the paper, NEJM has an editorial with some revealing statistics (more than 14,000 of the 101,000 patients listed for kidney transplantation are waiting for a repeat transplant) and a explanatory video. MedPage Today has an interview with Larsen, and HealthDay has a nice discussion of the issues surrounding post-transplant drugs.
Both mention how belatacept regimens have a drawback: a higher rate of acute rejection, which doctors can usually deal with, but is still a concern. To mitigate this, doctors at Emory Transplant Center are now researching the best ways of combining belatacept with other drugs. This abstract from the 2013 American Transplant Congress provides some details.
“This research has led to the refinement of our current regimen, where patients receive both tacrolimus and belatacept for the first 11 months, and then transition off of tacrolimus to hopefully avoid the long-term complications associated with tacrolimus therapy,” says Emory kidney transplant specialist Andrew Adams. “The goal is to position our patients to achieve the best long-term outcomes possible after transplant.”
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