*Purpose: To evaluate the impact of an alemtuzumab, belatacept, and sirolimus based regimen on renal function stratified by age in kidney transplant (KT) patients.

*Methods: This was a single center, retrospective analysis of KT patients receiving alemtuzumab for induction with denovo belatacept/sirolimus between 2016-2019. Cohorts included patients who were <55 years old (yo) versus >/=55 yo, received a KT alone, were >/=18 years, and EBV seropositive. The primary endpoint was GFR (MDRD or CKD-EPI) at 12 months (m). Secondary endpoints were GFR at 3, 6, 9m, incidence of biopsy proven acute rejection (BPAR), patient/graft survival at 12m, incidence of malignancy and infection, and medication tolerability. Descriptive statistics were performed.

*Results: Forty one patients (n=27 in <55 yo and n=14 in >/=55 yo) were included. Baseline demographics were similar between groups (figure 1) except for age. GFR at 12m was similar (51.5 ml/min vs 57.5 ml/min, respectively, p=0.32) (figure 2 and 3). Serum creatinine at 12m was higher in the <55 yo group (1.5 vs 1.1, respectively, p=0.02). BPAR and patient/graft survival were not different between groups. CMV viremia occurred in 6 patients in each group (22.2% vs 42.9%, respectively) and BK viremia occurred in 8 patients in the <55 yo group versus 3 in the >/=55 yo group. The most common infection was urinary tract infections (18.5% vs 14.3%, respectively). Malignancy occurred in 1 patient. The medication regimen was well tolerated with mouth ulcers (40.7% vs 42.9%, respectively) and leukopenia (66.7% vs 71.4%, respectively) as the most common ADR.

*Conclusions: Renal function by MDRD was preserved in both groups regardless of age in those receiving a maintenance regimen of belatacept/sirolimus after alemtuzumab induction. The regimen was well tolerated with excellent patient/graft survival.

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