Belatacept in renal transplantation in comparison to tacrolimus and molecular understanding of resistance pattern: Meta-analysis and systematic review

Figure 1 Pictorial depiction of mechanism of action of belatacept. APC: Antigen-presenting cell.

Figure 2 Search strategy and selections strategy applied in this meta-analysis as per PRISMA protocol.

Figure 3 Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Figure 4 Forest plot represents the changes at 12 mo in kidney transplant recipients when treated with belatacept or tacrolimus. Squares represent size effects of studies, comparing the weight of the study in the meta-analysis. 95 percent confidence intervals represented in horizontal bars. A: The eGFR at 12 mo in kidney transplant recipients; B: The biopsy proven acute rejection over 12 mo in kidney transplant recipients. The diamond shows significant favour towards tacrolimus group following random effect analysis; C: Graft survival over 12 mo in kidney transplant recipients. The diamond shows significant favour towards tacrolimus group following fixed effect analysis; D: The adverse events over 12 mo in kidney transplant recipients. The diamond doesn't suggest any significant difference following fixed effects analysis; E: The BK virus infection over 12 mo in kidney transplant recipients. The diamond doesn't suggest any significant difference following fixed effects analysis; F: The new onset diabetes mellitus after transplantation over 12 mo in kidney transplant recipients. The diamond suggests significant favour towards belatacept group following fixed effects analysis.

Figure 5 Forest plot represents the changes at 12 mo in kidney transplant recipients when treated with belatacept or tacrolimus. Squares represent size effects of studies, comparing the weight of the study in the meta-analysis. 95 percent confidence intervals represented in horizontal bars. A: The systolic blood pressure at 12 mo in kidney transplant recipients. The diamond doesn't suggest any significant difference following fixed effects analysis; B: The diastolic blood pressure at 12 mo in kidney transplant recipients. The diamond doesn't suggest any significant difference following random effects analysis; C: Serum total cholesterol at 12 mo in kidney transplant recipients. The diamond doesn't suggest any significant difference following fixed effects analysis; D: Serum triglycerides at 12 mo in kidney transplant recipients. The diamond doesn't suggest any significant difference following fixed effects analysis; E: Serum low density lipoprotein at 12 mo in kidney transplant recipients. The diamond suggests favour towards belatacept group following fixed effects analysis.

Figure 6 Factors modified by belatacept and tacrolimus based regimen. BPAR: Biopsy proven acute rejection; NODAT: New onset diabetes mellitus after transplantation; Serum LDL: Serum low density lipoprotein.

Figure 7 Mechanism of the development of resistance to belatacept.