{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:55:21Z","timestamp":1788893721273,"version":"build-2803163510"},"reference-count":6,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T00:00:00Z","timestamp":1710806400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Belatacept (BTC), a fusion protein, selectively inhibits T\u2010cell co\u2010stimulation by binding to the CD80 and CD86 receptors on antigen\u2010presenting cells (APCs) and has been used as immunosuppression in adult renal transplant recipients. However, data regarding its use in heart transplant (HT) recipients are limited. This retrospective cohort study aimed to delineate BTC's application in HT, focusing on efficacy, safety, and associated complications at a high\u2010volume HT center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was conducted of patients who underwent HT between January 2017 and December 2021 and subsequently received BTC as part of their immunosuppressive regimen. Twenty\u2010one HT recipients were identified. Baseline characteristics, history of rejection, and indication for BTC use were collected. Outcomes included renal function, graft function, allograft rejection and mortality. Follow\u2010up data were collected through December 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 776 patients monitored from January 2017 to December 2021 21 (2.7%) received BTC treatment. Average age at transplantation was 53 years (\u00b1\u00a012 years), and 38% were women. BTC administration began, on average, 689 [483, 1830] days post\u2010HT. The primary indications for BTC were elevated pre\u2010formed donor\u2010specific antibodies in highly sensitized patients (66.6%) and renal sparing (23.8%), in conjunction with reduced calcineurin inhibitor dosage. Only one (4.8%) patient encountered rejection within a year of starting BTC. Graft function by echocardiography remained stable at 6 and 12 months posttreatment. An improvement was observed in serum creatinine levels (76.2% of patients), decreasing from a median of 1.58 to 1.45 (IQR [1.0\u20132.1] to [1.1\u20131.9]) over 12 months (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.054). eGFR improved at 3 and 6 months compared with 3 months pre\u2010 BTC levels; however, this was not statistically significant (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.24). Treatment discontinuation occurred in seven patients (33.3%) of whom four (19%) were switched back to full dose CNI. Infections occurred in 11 patients (52.4%), leading to BTC discontinuation in 4 patients (19%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this cohort, BTC therapy was used as alternative immunosuppression for management of highly sensitized patients or for renal sparing. BTC therapy when combined with CNI dose reduction resulted in stabilization in renal function as measured through renal surrogate markers, which did not, however, reach statistical significance. Patients on BTC maintained a low rejection rate and preserved graft function. Infections were common during BTC therapy and were associated with medication pause\/discontinuation in 19% of patients. Further randomized studies are needed to assess the efficacy and safety of BTC in HT recipients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15251","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T06:43:30Z","timestamp":1710917010000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Utility of a fusion protein T\u2010cell co\u2010stimulation blocker Belatacept in heart transplant recipients: Real world experience from a high volume center"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2447-3713","authenticated-orcid":false,"given":"Daniel","family":"Oren","sequence":"first","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matan","family":"Uriel","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathrine M.","family":"Moeller","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Fernandez","family":"Valledor","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"},{"name":"Columbia University Irving Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0493-1326","authenticated-orcid":false,"given":"Ersilia M.","family":"DeFilippis","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dor","family":"Lotan","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo C.","family":"Colombo","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melana","family":"Yuzefpolskaya","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veli K.","family":"Topkara","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8351-9219","authenticated-orcid":false,"given":"Kevin J.","family":"Clerkin","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8561-7899","authenticated-orcid":false,"given":"Jayant K.","family":"Raikhelkar","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin A.","family":"Fried","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David (Kyung Taek)","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York 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Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Takeda","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Choe","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas L.","family":"Jennings","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Majure","sequence":"additional","affiliation":[{"name":"Division of Cardiology Advanced Cardiac Care Weill\u2010Cornell Medical College  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhana","family":"Latif","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Sayer","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Uriel","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Cardiology Irving Medical Center Columbia University New York Presbyterian  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03976.x"},{"key":"e_1_2_8_3_1","unstructured":"European Medicines Agency. Nulojix: European Public Assessment Report \u2014 summary for the public."},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050085"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15584"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13886"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.15251","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T16:52:28Z","timestamp":1711385548000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.15251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":6,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/ctr.15251"],"URL":"https:\/\/doi.org\/10.1111\/ctr.15251","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]},"assertion":[{"value":"2023-08-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e15251"}}