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Biologics in Transplantation (Anti-thymocyte Globulin, Belatacept, Alemtuzumab): How Should We Use Them?

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Purpose of Review

The use of immunosuppressive agents for induction and maintenance therapies continues to vary widely among countries and transplant centers. This review will consolidate the published body of evidence addressing the effectiveness and safety of the use of three biological agents: anti-thymocyte globulin, alemtuzumab, and belatacept in adult kidney transplant recipients.

Recent Findings

Clinical evidence clearly supports the use of Thymoglobulin in high immunological risk patients, while its benefit in low immunological risk patients remains controversial. Alemtuzumab has the advantage of easy administration with comparable efficacy to Thymoglobulin but concerns regarding increased risk for late rejection. Belatacept is the newest biological agent. It is associated with higher glomerular filtration rates compared to cyclosporine. Belatacept has not been compared to tacrolimus or studied in high immunological risk patients in sufficiently large numbers.


Tailoring immunosuppressive therapy to patient’s characteristics and immunological risk is the key for successful transplantation.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

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Correspondence to Reem Daloul.

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The primary author and all involved coauthors of this article have no financial or non-financial conflict of interest to declare. The manuscript is original and is currently not under consideration by any other journal and has not been published before.

Sagar Gupta and Reem Daloul declare no conflict of interest.

Daniel Brennan reports grants from Alexion, Astellas, Bristol-Meyer Squib, Shire, Pfizer, and Veloxi and personal fees from Alexion, Astellas, Novartis, Sanofi, and Veloxis, outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Kidney Transplantation

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Daloul, R., Gupta, S. & Brennan, D.C. Biologics in Transplantation (Anti-thymocyte Globulin, Belatacept, Alemtuzumab): How Should We Use Them?. Curr Transpl Rep 4, 82–90 (2017). https://doi.org/10.1007/s40472-017-0147-8

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  • Thymoglobulin
  • Alemtuzumab
  • Belatacept
  • Induction
  • Immunotherapy
  • Kidney transplant
  • Maintenance therapy