*Purpose: Belatacept based immunosuppression regimens in kidney transplant recipients have been associated with better kidney function, improved metabolic profile, less de novo DSA formation and improved preformed DSA at the expense of a higher risk of acute rejection. The transient addition of tacrolimus to de novo Belatacept, mycophenolate and steroids regimen, appears to reduce the risk of rejection without apparent increased risk of BK or CMV viremia.

*Methods: We sought to retrospectively evaluate the safety and early outcomes (6-month follow-up) of adult kidney, pancreas and kidney pancreas recipients undergoing conversion from standard immunosuppression to a 4-drug regimen consisting of belatacept, steroids, mycophenolate or azathioprine and calcineurin inhibitors at a single transplant center.

*Results: We identified 18 transplant recipients (16 kidney, 1 pancreas and 1 kidney-pancreas) with a mean age of 42±15 years. 27.8% were female, 44.4% black race and 22.2% CMV-high risk. Most donors were deceased (88.9%) with a mean KDPI 38±27. All patients were induced with anti-thymocyte globulin. Most common indication for quadruple regimen was tacrolimus intolerance (44.4%). Median time to quadruple regimen initiation from transplant was 201 days (IQR 96-1068). All patients received a belatacept maintenance dose of 5mg/kg every 28 days. The mean eGFR was 46.2±24.9ml/min before and 55.4±22.8 ml/min 6-months after 4-drug regimen initiation (p=0.04). Tacrolimus level at 1 month post initiation was 6.5±2.8 ng/mL and 4.2±2.2 ng/mL by 6 months. No patient had acute rejection and all allografts were functioning at 6 months. The incidence of CMV viremia and BK viremia were 11% for each. No cases of PTLD or EBV viremia were reported.

*Conclusions: Our study illustrates the early 6-month outcomes and safety of belatacept based 4-drug maintenance immunosuppression regimen. There was evidence of eGFR improvement at 6 months and limited incidence of viral infections. Longer follow up and prospective randomized trials are needed to confirm these results.

« Back to 2022 American Transplant Congress