*Purpose: To review our experience with Belatacept in pancreas transplantation

*Methods: Retrospective review including all patients receiving Belatacept after pancreas transplantation. Main objective is to review rejection rate, de novo anti-HLA antibodies, infection rate and pancreas and patient survival

*Results: 27 patients (EBV+) received Belatacept (2 de novo and 25 conversions) due to CNI toxicity (11), kidney (5) or pancreas (3) dysfunction, AMR with anti-HLA Ab (6), high cardiovascular risk (1) and a partial pancreas (1). Tacrolimus was minimized in 11 cases and discontinued in 16. With a mean f/u of 2.1 years (0.4-3.5y), there were 3 rejection episodes (1Kid, 1Pan, 1KP) at 7, 11 and 27 mo. Two of them had history of previous rejection episodes. 2/14 patients with initially negative antibodies developed de novo DSA (1) or non DSA (1) antibodies and 3/13 patients with positive antibodies became negative after Belatacept use. The group of patients with kidney dysfunction (creatinine above 2.5), was started on Belatacept with tacrolimus discontinuation to delay the progression to kidney failure. In this group mean time to dialysis was 21 mo (13-30mo). There were only two infection cases, one due to CMV and the other by the fungus Histoplasma capsulatum. The latter appear after treatment for rejection with steroid pulses and Thymoglobulin and was the only case registered of mortality, among the 27 patients treated with belatacept. There were no pancreas graft losses

*Conclusions: In selected cases Belatacept may play a role in pancreas immunosuppression

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