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<p>This systematic review and meta-analysis evaluated the risk of cytomegalovirus (CMV) and BK virus infections in kidney transplant recipients receiving belatacept-based immunosuppression compared to calcineurin inhibitor (CNI)-based regimens. Seven studies (six randomized controlled trials and one cohort study) involving 1,625 patients were analyzed. Pooled results showed little to no evidence of a difference in CMV infection risk between belatacept and CNI-treated patients (odds ratio [OR] 1.24, 95% confidence interval [CI] 0.80–1.94; <i>P</i> = 0.34). However, there was little to no evidence of a difference in BK virus infection risk, though the point estimate suggested a possible increase (OR 2.11, 95% CI 0.71–6.33, <i>P</i> = 0.18). Heterogeneity was low across studies (I² = 0%). A sensitivity analysis excluding the single non-randomized cohort study (i.e., restricted to the randomized controlled trials) showed little to no evidence of a difference in CMV infection risk (OR 1.16, 95% CI 0.57–2.37; <i>P</i> = 0.69). While belatacept offers renal and metabolic advantages over CNIs, the potential for CMV and BK viremia necessitates careful monitoring, particularly in high-risk patients. Standardized viral surveillance and further research in larger cohorts are needed to clarify long-term infection risks.</p>

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Cytomegalovirus and BK polyomavirus in belatacept-treated kidney transplant recipients: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Ibrahim Tawhari,
  • Fatma Yamani,
  • Manal Alotaibi,
  • Hany El Hennawy,
  • Mohammed Tawhari,
  • Muath Alqahtani,
  • Khalid Asiri

摘要

This systematic review and meta-analysis evaluated the risk of cytomegalovirus (CMV) and BK virus infections in kidney transplant recipients receiving belatacept-based immunosuppression compared to calcineurin inhibitor (CNI)-based regimens. Seven studies (six randomized controlled trials and one cohort study) involving 1,625 patients were analyzed. Pooled results showed little to no evidence of a difference in CMV infection risk between belatacept and CNI-treated patients (odds ratio [OR] 1.24, 95% confidence interval [CI] 0.80–1.94; P = 0.34). However, there was little to no evidence of a difference in BK virus infection risk, though the point estimate suggested a possible increase (OR 2.11, 95% CI 0.71–6.33, P = 0.18). Heterogeneity was low across studies (I² = 0%). A sensitivity analysis excluding the single non-randomized cohort study (i.e., restricted to the randomized controlled trials) showed little to no evidence of a difference in CMV infection risk (OR 1.16, 95% CI 0.57–2.37; P = 0.69). While belatacept offers renal and metabolic advantages over CNIs, the potential for CMV and BK viremia necessitates careful monitoring, particularly in high-risk patients. Standardized viral surveillance and further research in larger cohorts are needed to clarify long-term infection risks.