*Purpose: With the onset of the COVID-19 pandemic, many people in the United States were urged to stay at home. Kidney transplantation continued during this time, albeit at a reduced pace. We examined if there was increased utilization of belatacept during the pandemic in fresh transplant recipients, as this would potentially decrease need for blood draws for monitoring medication troughs.

*Methods: The UNOS STARfile was queried to examine all patients who received a kidney transplant between 3/1/2020 – 5/31/2020 (COVID era, COVID). All kidney transplants performed during 3/1/2019 – 5/31/2019 were defined as the pre-COVID era (Pre). In each era, patients were divided based upon belatacept (Bela) immunosuppression vs. non-belatacept (N) immunosuppression. The four groups examined included COVID/belatacept (COVID-Bela), pre-COVID/belatacept (Pre-Bela), COVID/non-belatacept (COVID-N), and pre-COVID/non-belatacept (Pre-N).

*Results: There were 9563 transplants performed over both periods, of which 4171 (43.6%) were performed during COVID (118 or 2.8% COVID-Bela, 4053 or 97.2% COVID-N) and 5392 were performed pre-COVID (56.4%) (153 or 2.8% with Pre-Bela, 5239 or 97.2% Pre-N). Donor KDPI was significantly higher in both belatacept groups (57% COVID-Bela, 58% Pre-Bela vs. 44% COVID-N, 47% Pre-N, p<0.0001), along with a longer cold storage time (19.6 h COVID-Bela, 17.3 h Pre-Bela vs. 15.1 h COVID-N, 13.7 Pre-N, p<0.0001) and higher donor creatinine (1.66 mg/dL COVID-Bela, 1.63 mg/dL Pre-Bela vs. 1.33 mg/dL COVID-N, 1.32 mg/dL Pre-N, p<0.002). Recipients in the belatacept groups were also significantly older (55.8 y COVID-Bela, 55.2 y Pre-Bela vs. 51.9 y COVID-N, 52.9 y Pre-N, p<0.0001), had a higher EPTS (0.53 COVID-Bela, 0.50 Pre-Bela vs. 0.46 COVID-N, 0.47 Pre-N, p=0.03), higher creatinine at discharge (5.68 mg/dL COVID-Bela, 4.37 mg/dL Pre-Bela vs. 4.20 mg/dL COVID-N, 3.74 mg/dL Pre-N, p<0.0001), and greater delayed graft function (DGF) (42.4% COVID-Bela, 30.7% Pre-Bela vs. 23.1% COVID-N, 23.2% Pre-N, p<0.0001). Regions 3, 4, and 5 had the greatest utilization of belatacept during the COVID era at 29.7%, 25.4%, and 8.5%, respectively.

*Conclusions: Despite stay at home recommendations, utilization of belatacept did not increase during the COVID era. Belatacept immunosuppression continued to be used in higher KDPI kidneys in older recipients as had been done in the pre-COVID era. Transplantation during COVID brought longer cold storage times and greater DGF, but belatacept potentially has allowed utilization of kidneys that might have otherwise been discarded during the COVID era.

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