*Purpose: Extensive adverse effect profiles including neurotoxicity, manifesting as short-term memory loss, make CNIs less desirable despite their efficacy preventing acute rejection and increasing graft and patient survival. The increased risk for neurocognitive dysfunction induced by CNIs has been long recognized, but not well characterized by formal neurocognitive assessment. Furthermore, to what extent neurocognitive improvement occurs after CNI discontinuation is even less well known. Unlike improvements in renal function, which have an objective laboratory measure, improvements in neurocognition require more complex assessment to quantify.

*Methods: Traditional cognitive assessment instruments are time intensive, costly, and ideally are administered by a formally trained assessor. The NIH Toolbox Cognition Battery (NIHTB-CB) offers many of the advantages of a traditional assessment, but via a semi-automated computer program administered on an iPad platform. Testing takes less than 45 minutes to administer and our team rapidly mastered the testing procedure and software interface. We performed a pilot study using the NIHTB-CB to measure neurocognitive function in 20 patients converted from tacrolimus to belatacept immunosuppression. A test-retest study design was utilized whereby patients were assessed prior to conversion to belatacept and retested within 6 months following discontinuation of tacrolimus.

*Results: Patients experienced a statistically significant improvement in raw test scores for: Attention & Executive Function, Episodic Memory, Processing Speed, and the Cognition Fluid Composite Scores. A trend toward an improvement in Working Memory was also seen but did not achieve statistical significance. Executive Function did not show any changes following conversion (see Table). Scores remained on average below the general population mean even after normalizing for age, educational level, ethnicity, and sex.

*Conclusions: Our pilot study assessing Cognition after Belatacept conversion substantiates the patient reported perception that cognitive function is mildly impaired on tacrolimus and demonstrates that recovery of this impairment is possible following conversion to belatacept. Furthermore, this pilot study confirms that neurocognitive assessment can be performed by transplant clinicians in the clinic setting using the NIHTB-CB testing platform.

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