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Abstract: TH-PO829

Long-Term Outcomes Comparing Belatacept- vs. Tacrolimus-Based Maintenance Immunosuppression in Kidney Transplant Recipients: A UNOS Database Analysis

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Montalvan, Adriana, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Canizares Quisiguina, Stalin Isaias, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Eckhoff, Devin, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Lee, David Donghyung, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Chopra, Bhavna, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Calcineurin-inhibitors have been the mainstay of maintenance immunosuppression in kidney transplant recipients (KTRs), which is associated with nephrotoxic risks. Several immunosuppressants have been tried as nephron sparing agents but with limited success. We compared long-term outcomes of KTRs on tacrolimus (Tac) vs belatacept (Bela) based maintenance immunosuppression.


Using the UNOS Standard Transplant Analysis and Research (STAR) file to identify adult, first KTRs only from 2010 to 2022 who received induction therapy. Patients were categorized based on Tac or Bela based maintenance immunosuppression at discharge. Multivariate cox regression models adjusting for several donor, transplant and recipient factors were used to compare graft, death-censored graft failure (DCGF) and patient death in all KTR and further stratified by donor type.


A total of 194307 and 5152 patients on Tac and Bela were identified. Compared to patients discharged on Tac, subjects discharged on Bela were more likely to be older (53.5y vs 52.1y), African American (35.2% vs 27.3%), and diabetic (36.6% vs.34.5%), had greater time on dialysis (974d vs 913d), and received higher KDPI kidneys (36 vs 23) (p<0.05). Results of all KTRs and further stratified by donor type are shown in Table 1. Outcomes were similar in living donor KTRs; in deceased donor KTRs, Bela was associated with increased risk of death and DCGF.


Based on demographic and clinical data, patients discharged on Bela as maintenance therapy had higher comorbid burden. Our study found increased DCGF and patient death in the Bela group, which might be related to increased comorbidity, risk of early rejections despite the reduced nephrotoxic effects, and possibly increased viral and fungal infections associated with Bela. Retrospective nature and selection bias are major limitations of database study. Randomized controlled trials comparing Bela vs Tac are awaited.

Outcomes of all, deceased and living donor kidney recipients based on immunosuppression maintenance at discharge
 Patient Death
HR (95%CI); p
Adjusted Overall Graft Failure
HR (95%CI); p
Death Censored Graft Failure
HR (95%CI); p
All patients
Tac(n=194307) vs Bela(n=5152)
0.89 (0.82-0.97); 0.0090.97 (0.90-1.05); 0.4570.85 (0.78-0.94); 0.001
Deceased Donor
Tac(n=3722) vs Bela(n=134583)
0.89 (0.82-0.97); 0.0090.97 (0.90-1.05); 0.4570.85 (0.78 - 0.94); 0.001
Living Donor
Tac(n=59724) vs Bela(n=1430)
0.87 (0.74-1.03); 0.1150.97 (0.82-1.14); 0.6830.92 (0.75-1.12); 0.398