*Purpose: New immunosuppressive agents in transplant should not only be efficacious but also help patients feel better (i.e. lower patient reported symptoms and improve health related quality of life (HRQoL). Herein, we analyzed patients in the BENEFIT and BENEFIT-EXT trials longitudinally to determine the relative symptom and HRQoL differences between cyclosporine (CsA) and belatacept.

*Methods: Patients were evaluated using the SF-36 (HRQoL) and the MTSOSD-59R (symptom) at baseline, 12, 24, and 36 months post-transplant for SF-36 (n=831) and MTSODS-59R (n=394, inclusive of patients who reported SF-36). We examined change from baseline and differences between treatment groups for all 8 subscales of the SF-36. The most distressing symptoms were identified and compared by treatment over time using ridit analysis.

*Results: Overall, compared to CsA, belatacept treated patient had better HRQoL scores post-transplant across most SF-36 subscales (Figure A). Between treatment groups, there were a higher number of distressing symptoms (p<0.01) in CsA treated patients at 12, 24, and 36 months post-transplant relative to belatacept treated patients. The symptoms that highly differentiated cyclosporine from belatacept were trembling hands, feeling of warmth in hands and feet, swollen ankles, change in facial features, increased hair growth, muscle cramps, and swollen gums (Figure B). No symptoms appeared more distressing in patients treated with the belatacept less intense (LI) regimen.

*Conclusions: Belatacept treatment (compared to CsA) resulted in improved HRQoL and lower symptom distress. Therefore, in addition to some clinical benefit of belatacept (i.e. lower DSA, improved graft survival), belatacept patients also feel better and have a better quality of life.

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