*Purpose: Racial disparities in outcomes of kidney transplant recipients (KTxR) are well-described for early steroid withdrawal (ESW) under calcineurin inhibitor (CNI)-based regimens, however little data exist under belatacept (BELA)-based regimens in African American (AA) KTxR. This study compared results from the BEST trial in AA and nonAA KTxR.

*Methods: The BEST Trial was a prospective, randomized, multi-center trial designed to compare two BELA-based, CNI-free, ESW regimens with a standard tacrolimus (TAC)-based ESW regimen in combination with depleting induction. A subgroup analysis was performed for AA vs nonAA KTxR. The primary endpoint was patient death, renal allograft loss, or eGFR <45ml/min/1.73m² at 12 months.

*Results: Forty-two AA KTxR were enrolled in this study. Demographics were similar across groups with the exception of more deceased donors in the AA group. Outcomes by race and treatment group are shown in Table 1. Time to rejection based on regimen and race is shown in Figure 1. AA pts had similar primary outcome rates in all 3 treatment groups with highest rejection rates in the rATG/BELA groups. Unlike non-AA, there did not seem to be a benefit in eGFR or toxicity with BELA use in AA. MVA results for BPAR are presented in Figure 2.

*Conclusions: Preliminary evidence suggests that AA pts may not experience benefits from BELA use that are comparable to non-AA, with potentially significantly higher BPAR particularly in the rATG/BELA group. Larger studies are warranted to better discern risk/benefit profiles with BELA-based ESW regimens based on KTxR race.

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