Does Early Belatacept Conversion in Delayed Graft Function Preserve Allograft Function?

Background: Calcineurin inhibitors (CNIs) remain the cornerstone of immunosuppression in renal transplantation. However, there remain concerns regarding CNI induced nephrotoxicity. Belatacept is an alternative to nephrotoxic CNIs and has been FDA approved for immunosuppression in renal transplantation since 2011. The purpose of this case series is to identify short-term outcomes of early belatacept conversion in prolonged delayed graft function (DGF). Methods: DGF includes patients who required dialysis within the first 2 weeks post-transplant. Early Belatacept conversion occurs within the first 6 months post-transplant. Charts were individually audited for data collection. Demographic data included age, gender, race, BMI, history of diabetes, and new onset diabetes after transplantation, HLA mismatch, KDPI, cPRA, EBV, CMV, BK virus, donor type, prior transplants, pre-transplant dialysis dependence, dialysis length, biopsy, steroid use, neutropenia. Outcomes included creatinine, GFR, PTLD, infections and withdrawal from dialysis. SPSS was used for statistical analysis. Results: This case series included 19 patients. Transplantation occurred from 2012-2023. Patient demographics are Figure 1. Patients had a statistically significant improvement in creatinine and GFR in 6 months. Additional complications included new onset diabetes after transplantation and acute cellular mediated rejection in 1 patient each. All patients were weaned off dialysis except one. No patients developed PTLD. Conclusion: This case series suggests early conversion to Belatacept in DGF results in preserved short-term graft function. This case series adds to the current literature suggesting that the long term outcomes of Belatacept warrants further study.Fig 1. Demographics. (DCD = death after cardiac death; DBD = donation after brain death; HLA MM = Human Leukocyte Antigen Mismatch; Neutropenia: WBC <2.1). Pre and Post-conversion GFR - Pre-conversion GFR Post-conversion GFR Median [25th, 75th percentile] 13.5 [6.0, 25.5] 35.5 [26, 42.5] Mean ± SD 16.4 ± 10.7 34.3 ± 11.0 Wilcoxon Signed Rank Test used to determine statistical significance (P<0.001).