BELATACEPT INJ,LYPHL
Clinical Criteria Summary
General Criteria Structure
- All mandatory inclusion criteria must be met.
- At least one additional inclusion criterion must also be met.
Transplant Recipient Status & Clinical Indications
- Veteran is a kidney transplant recipient
- Chronic allograft nephropathy or calcineurin inhibitor (CNI) toxicity on biopsy
- Unmanageable CNI intolerance (e.g., tremors, headache, thrombotic microangiopathy, post-transplant diabetes)
- Preference for avoidance or minimization of long-term CNI exposure
- Chronic antibody-mediated rejection or donor-specific antibody suppression
Provider & Care Coordination Requirements
- Requesting provider must be a nephrologist or post-kidney transplant designee (e.g., locally designated expert)
- Documentation must show concurrent communication with the transplant team
Infectious Disease Screening & Safety
- Veteran must be Epstein-Barr seropositive
- No active or untreated infections
- Tuberculosis screening completed within the past year (e.g., QuantiFERON gold)
Special Populations & Pregnancy Considerations
- For women of childbearing age: Confirm no alternative treatment exists and benefits outweigh risks due to limited/conflicting information regarding fetal harm risk.