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

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