*Purpose: The COVID19 pandemic has affected kidney transplant recipients (KTR) with a wide spectrum of clinical severity. Up to this point, we have solely seen reports describing outcomes of patients on calcineurin inhibitor-based regimens but there is a paucity of data regarding the use of belatacept (bela). Given the increased risk of viral infections seen with bela, this population is presumably at a higher risk for incidence and mortality of COVID19.

*Methods: This is a single center retrospective study of Sars-Cov-2 PCR positive KTR between April and September 2020 who were on bela based regimens compared with tacrolimus (tacro) based regimens. The primary outcome was death or ICU admission at any time during the COVID19 infection. Secondary outcomes were rate of graft loss and rate of co-infection with bacterial, fungal or other viral pathogens.

*Results: We identified 98 KTR who have been infected with Sars-Cov-2 of which 87 (84.4%) were on tacro and 11 (10.7%) were on bela. At our institution, currently there are 127 KTR on bela based maintenance immunosuppression; thus 11/127 (9%) developed COVID19. Mean age and gender was similar in both tacro and bela groups: (51 +/- 14 in tacro vs 57 +/- 12 in bela and 39% female in tacro vs 36% female in bela). Comorbidities (HTN, DM, COPD and HIV) were similar in both groups. Treatment was comparable and provided according to our current treatment protocols. Neither mortality (Figure 1) nor ICU admission was statistically significant between the groups (10% in tacro vs 9% in bela and 26% in tacro vs 27% in bela, respectively). Graft loss occurred in 5 (6%) of tacro patients and 1 (9%) of bela patients, not statistically significant. Co-infection with bacterial, fungal or viral pathogens in the tacro group occurred in 26 (30%), 8 (9%) and 5 (6%) of patients vs. 5 (45%), 1 (9%) and 0 patients in the bela group. These differences were not statistically significant.

*Conclusions: Although limited with a small sample size and single center observations, the use of belatacept did not appear to worsen outcomes in terms of mortality, ICU admission, graft failure or rate of co- infections when compared to tacrolimus.

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