Belatacept Safer than calcineurin inhibitors in Kidney Transplantation patients, reveals research

The analysis highlights that belatacept, a selective co-stimulation blocker targeting the CD28-CD80/86 pathway, avoids the chronic nephrotoxic effects associated with CNIs. This not only helps preserve long-term graft function but also improves patient outcomes by minimizing one of the most common causes of late graft failure. Importantly, the review underscores that CNI exposure contributes to DNA damage, impaired DNA repair, and oncogenic viral reactivation, all of which elevate cancer risk, especially for skin malignancies in immunosuppressed patients. Evidence from clinical studies and registry data suggests that belatacept-treated patients may have a lower incidence of NMSC compared to those receiving CNIs. In addition, belatacept appears to reduce the burden of metabolic complications such as hypertension and diabetes, further supporting its potential role in improving long-term survival. However, the authors caution that belatacept is not without risks. It has been associated with higher rates of early acute rejection episodes, particularly in Epstein-Barr virus (EBV)–seronegative patients, necessitating careful patient selection and monitoring. Overall, the findings indicate that belatacept could represent a safer, more sustainable option for kidney transplant recipients, especially those at higher risk for CNI-related toxicities and malignancies. The review emphasizes the need for long-term, large-scale studies to confirm these benefits and to optimize protocols for belatacept use in diverse patient populations. Reference Hennawy, H.M.E., Safar, O., Nassar, A. et al. Belatacept and non-melanoma skin cancer risk in kidney transplant recipients: a narrative review from a mechanistic and clinical perspective. BMC Nephrology 26, 487 (2025). https://doi.org/10.1186/s12882-025-04373-z