Transplantation Reports · Published 2026-06-23 · DOI 10.1016/j.tpr.2026.100207
Ahsan Aslam, Yang Li, Kathleen A. Lane, Oluwafisayo Adebiyi, Asif Sharfuddin, Sharon Moe, Muhammad Sohail Yaqub
Background: Calcineurin Inhibitors (CNI) and mammalian target of rapamycin inhibitors (mTORi) have been traditionally used as immunosuppressants to prevent rejection in kidney transplant recipients, but they are often associated with undesirable renal and metabolic adverse effects. Belatacept, a selective T-cell co-stimulation blocker, does not have undesirable effects. However, there is no data on using belatacept in combination with low dose calcineurin inhibitors (CNIs)/sirolimus. At our institution, patients are switched to this combination regimen if they have slow or delayed graft function, complications related to CNIs or graft rejection while on CNIs or sirolimus. Methods: We conducted a retrospective study evaluating all patients >18 years of age at Indiana University Hospital who had a kidney transplant and were switched from tacrolimus, sirolimus or cyclosporine to a combination of belatacept and lower dose CNI/sirolimus. A response to the addition of belatacept was defined as >10% change in the eGFR per year from baseline (pre-belatacept values) over 2 years. Logistic regression models were performed. Results: Seventy-nine subjects were included in the study with a mean age of 52.3 ± 14.7 years and followed up to 2.01 years (Median [IQR] = 1.02 [0.93, 1.99] years) post belatacept use. Response was observed in 54% of patients with improved eGFR by 6 months (p = 0.003) and sustained improvement at 2 years with an eGFR of 49.1 ± 19.5 vs. 35.3 ± 11.4 (p = 0.04; n = 13 each) in non-responders. The final multiple logistic regression model found having a retransplant (OR=5.81; 95% CI: 1.67–20.22; p = 0.006), log of higher level of proteinuria (OR=1.74; 95% CI: 1.08–2.78; p = 0.022), longer dialysis vintage before transplantation (OR=1.01; 95% CI: 1.00–1.03; p = 0.048) and history of graft rejection prior to the conversion to this regimen(OR=11.36;95% CI:1.84–70.07;p = 0.009) were all significantly associated with non-response. Conclusion: Belatacept in combination with low dose conventional immunosuppression appears to be a favorable option in patients with slow/delayed graft function or intolerance to conventional drugs at their usual therapeutic levels.
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Aslam, A., Li, Y., Lane, K., et al. (2026). Renal graft function outcomes after conversion from conventional immunosuppression regimen to belatacept plus low dose calcineurin inhibitor regimen: a single center study. Transplantation Reports. https://doi.org/10.1016/j.tpr.2026.100207