Early post-transplant conversion from tacrolimus to belatacept in kidney transplant patients Authors: Mikayla Morrow, Kwame Asare, Victoria Burnette, Nicole Melby
1)Background Ascension Saint Thomas Hospital West (ASTHW) began using belatacept, a selective T-cell co-stimulation blocker, in kidney transplant recipients more frequently in the fall of 2023. It is used if the patient has slow or delayed graft function post-transplant or experiences intolerance to or toxicity from calcineurin inhibitors. This was the first study at ASTHW evaluating outcomes of belatacept in this patient population. Previous studies that have compared calcineurin inhibitors, such as tacrolimus, to belatacept have found similar patient and graft survival between the groups, and found that belatacept recipients had superior renal function but experienced higher rejection. The purpose of this study was to assess the effect that early conversion from tacrolimus to belatacept post-kidney transplant has on patient renal function. 2)Methods This retrospective chart review included adult kidney transplant recipients transplanted at ASTHW between April 1, 2023 and April 31, 2025, who received either tacrolimus or belatacept within the first six months post-transplant. Data collected included demographics, transplant characteristics, induction therapy, immunosuppressive regimens, renal function, biopsy-proven acute rejection, incidence of delayed or slow graft function, incidence of infection , hospital length of stay after transplant, readmissions, and cost of therapy. Outcomes were analyzed using descriptive statistics; continuous variables with unpaired t-test and categorical variables with Chi-square or Fisher’s exact tests (alpha < 0.05).
3)Results Overall, 361 patients were screened and 285 were excluded for incomplete documentation. Of the 76 patients included, 19 were in the belatacept group and 57 in the tacrolimus group. There was a statistically significant difference in age between groups, with the belatacept group having an older median age (p = 0.045). The majority of patients were male and the study was split evenly between Caucasian and African American races. The majority of patients in both groups had slow graft function. Serum creatinine and estimated glomerular filtration rate were statistically significantly better in the tacrolimus-only group at 1, 3, and 6 months post-transplant (p = <0.00001). Survival of the patient and their graft, incidence of infection, and length of stay were not statistically different between groups. Biopsy proven acute rejection was statistically significantly higher in the belatacept group (p = 0.036). There was a statistically significant difference in the readmission rate between the groups, with the belatacept group having more readmissions (p = 0.0051). 4)Conclusions In this study of kidney transplant recipients receiving either tacrolimus, de novo belatacept, or who underwent early conversion from tacrolimus to belatacept, we observed a significant difference in renal allograft function in favor of tacrolimus use. Further studies are necessary to assess short- and long-term clinical outcomes of utilizing belatacept in place of tacrolimus in patients with slow or delayed graft function.
