Work

Belatacept Conversion in Simultaneous Pancreas‐Kidney and Liver‐Kidney Transplant Recipients: A Single‐Center Feasibility Cohort and Narrative Review

Year: 2026

Type: review

Abstract: BACKGROUND: Calcineurin inhibitor (CNI) nephrotoxicity drives long-term kidney-function decline after simultaneous pancreas-kidney (SPK) and liver-kidney (LK) transplantation, but belatacept conversion, as an alternative strategy, is poorly studied in these recipients, whose non-kidney allograft rejection risk differs. METHODS: We retrospectively studied six SPK and six LK recipients converted from CNI- to belatacept-based immunosuppression and analyzed the cohorts separately alongside a narrative review of published SPK/LK conversion experiences. Outcomes were estimated glomerular filtration rate (eGFR) trajectories and slopes, donor-specific antibodies (DSA) and rejection, pancreatic, hepatic and metabolic parameters, infections, and survival, reported descriptively with exploratory estimates and 95% confidence intervals (CI). RESULTS: and the median eGFR slope changed from -3.9 to +5.6 mL/min/year (mixed-model slope change +12.6, 95% CI 2.9 to 22.3); in LK recipients, from 38.8 to 46.3 and from -3.1 to +4.1 (estimate +6.3, 95% CI -4.2 to 16.7). No new DSA developed; pre-existing DSA declined or remained stable. Pancreatic and liver function stayed stable. Two infections in LK recipients (Pneumocystis pneumonia, adenovirus) were possibly belatacept-aggravated. Over a median 25 months, 8/12 (67%) remained on belatacept. CONCLUSIONS: Late belatacept conversion with a transient low-dose CNI overlap was feasible in selected SPK and LK recipients and was associated with stable-to-improved kidney function without a pancreatic or hepatic safety signal. The uncontrolled design supports feasibility, not efficacy.

Source: Clinical Transplantation

DOI: 10.1111/ctr.70719