*Purpose: Immunosuppressive strategies for belatacept are variable and associated outcomes have not been well described. We examined outcomes among kidney transplant (KT) recipients converted from tacrolimus to belatacept-based regimens with or without corticosteroids (CS).

*Methods: Retrospective study of adult patients who underwent KT between 02/2014 and 11/2017 and were converted from tacrolimus to belatacept-based regimens within 6 months post-transplant. Patients were stratified on whether conversion was accompanied with newly initiated CS therapy. Outcomes of interest included rejection, kidney function, infections, and patient and allograft survival at 12-months post-conversion.

*Results: We identified 50 patients who were converted from tacrolimus to belatacept maintenance immunosuppression during the study period; 21 (42%) were converted with newly initiated CS. Following conversion, rejection was similar in the CS group (9.5%) compared to the non-CS group (10.3%) (p=1.000). Mean SCr at 12 months post-conversion was 2.8 ± 1.4 mg/dL and 3.0 ± 1.6 mg/dL in the CS and non-CS groups, respectively (p=0.670). There were no differences in the incidence of viral or urinary tract infections. Patient survival was 100% in both groups at 12 months post-conversion, and there was no difference in graft survival 95.2 vs 82.8% (p=0.246) (Table 2).

*Conclusions: Patients undergoing early (within 6 months of KT) conversion to a belatacept-based regimen with CS experienced a similar number of rejection and infection episodes compared to those converted without CS. Further study of larger populations to evaluate belatacept conversion regimen outcomes are needed.

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