{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T14:07:38Z","timestamp":1789222058360,"version":"build-2803163510"},"reference-count":78,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":254,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Transplantation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The long\u2010term risk of cytomegalovirus (CMV), Epstein\u2013Barr virus (EBV)\u2010associated post\u2010transplant lymphoproliferative disorder (PTLD), and BK viral infections from belatacept is unclear. This review aimed to evaluate these outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Several databases were reviewed from inception through September 2025 using the keywords \u201cbelatacept\u201d and \u201ckidney transplant\u201d or \u201csafety\u201d and \u201cviral infection\u201d. We included case reports, randomized controlled trials (RCTs), and nonrandomized trials (NRTs). Outcomes were prespecified according to dose (more\u2010intense or less\u2010intense), type of infection (CMV, EBV\u2010PTLD, or BK), and follow\u2010up period: short term (1\u20132\u2009years), medium term (3\u20135\u2009years), and long\u2010term (&gt;\u20095\u2009years). RCTs and NRTs were analyzed separately, and case reports were summarized. For binary outcomes, results were presented as risk ratios (RR), with 95% confidence intervals (CI). All statistical analyses were performed using Revman 5.2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty\u2010four studies (23 RCTs, 28 NRTs, and 13 case reports) were included. Of 23 RCTs, 11 were primary studies while the remainder were follow\u2010up reports of original RCTs. Most NRTs (16\/28) included a comparator arm. In the meta\u2010analyses of RCTs only, the risks of CMV, EBV\u2010PTLD, and BK virus infection were similar between patients receiving belatacept and those receiving calcineurin inhibitors (CNIs). During medium\u2010term follow\u2010up for RCTs, BK virus infection was twice as likely among those receiving more\u2010intense compared to less\u2010intense belatacept (RR: 2.08 [CI 1.03, 4.20,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0]). Among NRTs, the risk of CMV infection was two\u2010fold higher among those receiving belatacept versus CNI, with an RR of 2.15 [CI 1.58, 2.93,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 66%]; BK DNAemia or viremia was also greater than two\u2010fold higher, with an RR of 2.59 [CI 1.10\u20136.11].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The risks of CMV and EBV\u2010PTLD after kidney transplantation were not significantly increased by belatacept based on RCTs, though a higher risk of BK polyomavirus infection was observed among patients receiving a more\u2010intense dose of belatacept beyond the second year. The risk of CMV and BK polyomavirus infections may also be increased with real\u2010world belatacept use. However, these observations should be interpreted with consideration for the inherent limitations of NRTs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/joot\/3256272","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T13:50:16Z","timestamp":1789221016000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Belatacept and the Risk of Cytomegalovirus, BK Polyomavirus, and Epstein\u2013Barr Virus Post\u2010transplant Lymphoproliferative Disease After Kidney Transplantation: A Meta\u2010Analysis and Systematic Review"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5183-8239","authenticated-orcid":false,"given":"Cybele Lara R.","family":"Abad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5248-0227","authenticated-orcid":false,"given":"Raymund R.","family":"Razonable","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"e_1_2_15_1_2","doi-asserted-by":"publisher","DOI":"10.5414\/cnp57409"},{"key":"e_1_2_15_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa020009"},{"key":"e_1_2_15_3_2","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1093\/ajhp\/61.6.565","article-title":"Drug-Related Dyslipidemia After Renal Transplantation","volume":"61","author":"Mathis A. 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