Purpose: Evaluate the result of conversion to belatacept from calcineurin inhibitor (CNI) or TOR inhibitor based regimens due to toxicities in kidney transplant recipients (KTR).

Methods: A retrospective chart review was conducted of adult KTR at our center who were converted to belatacept from either a CNI or TOR inhibitor. Data was collected at baseline, 1 month, 3 months and 6 months post-conversion. Primary outcome was indication for changing immunosuppression. Secondary outcomes include change in toxicity, change in renal function using serum creatinine (SCr) and calculated creatinine clearance (CrCl), rates of failed conversion, biopsy proven acute rejection (BPAR) and infection. Student's t-test was used to compare renal function changes.

Results: Twenty three patients were included in this analysis. Fourteen patients were converted from a CNI regimen and nine patients were converted from an mTOR. For patients converted from CNIs, twelve (85.7%) were converted for neurotoxicities and two (14.3%) for other indications. For patients converted from TORs, indications include hyperlipidemia (33.4%), edema (22.2%), pneumonitis (22.2%), and wound healing (22.2%). Of these, 17 patients (73.9%) had improvement in their indication after converting to belatacept. Three patients (13%) did not have improvement and in three patients (13%) failed conversion to belatacept due to infusion related adverse effects. Other adverse events include one urinary tract infection (UTI), one resistant CMV viremia, and one case of BPAR requiring treatment.

Conclusion: The majority of toxicities resolved upon conversion to belatacept. In the conversion from CNIs there was an additional benefit of improved renal function.

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