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Abstract: SA-PO281

Long-Term Outcomes Comparing Belatacept vs. Tacrolimus in Older and Marginal Kidney Transplant Recipients: A UNOS Database Analysis

Session Information

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

  • 2000 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)


  • Canizares Quisiguina, Stalin Isaias, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Montalvan, Adriana, 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

Studies have shown that kidney transplantation with even a marginal kidney provides a survival advantage in older patients when compared to dialysis. Older kidney transplant recipients (KTR) of marginal organs where KDPI ≥85% are more likely to be negatively impacted by the nephrotoxic effects of calcineurin inhibitors. Hence, the aim of the study was to compare long term patient and graft outcomes in older and high KDPI KTRs stratified by Tacrolimus (Tac) vs Belatacept (Bela) maintenance immunosuppression.


We identified adult, first-time kidney only transplant recipients from 2010 to 2022 who received induction therapy and were discharged on Tac or Bela based maintenance immunosuppression from the UNOS database. Multivariate Cox regression models adjusting for several donor, transplant and recipient factors were used to compare long term outcomes Tac vs. Bela maintenance in KTRs with age ≥65 yrs, KDPI ≥85%, and donation after cardiac death (DCD).


The results comparing Tac vs. Bela groups are detailed in Table 1. Bela use was associated with higher DCGF and death in KDPI ≥85% group (p<0.05). The rest of the long-term outcomes were similar between the groups.


The use of Bela in older KTRs recipients and DCD kidney recipients is associated with non-inferior outcomes, likely due to GFR advantage with Bela. Inferior outcomes in the Bela group among high KDPI KTRs could reflect selection bias. Other contributory factors could include higher risk for early rejections and opportunistic infections in the Bela group. These identified associations should be regarded as preliminary evidence, taking into account the retrospective nature of the study. They serve as a catalyst for future analysis.

Comparison of long-term outcomes in older and marginal kidney transplant recepients based on maintenance immunosuppression.
 Delayed Graft Function Tacro (%) vs. Bela (%); pPatient
HR (95%CI); p
Adjusted Overall Graft Failure
HR (95%CI); p
Death Censored Graft Failure
HR (95%CI); p
Recipient Age > 65 years
Tac (n = 39855) vs. Bela (n = 1241)
9380 (23.54%) vs. 410 (33.04%); <0.0010.88 (0.78-1.00); 0.0570.98 (0.86-1.10); 0.7230.89 (0.77-1.03); 0.109
KDPI >85%
Tac (n = 9258) vs Bela (n = 422)
3273 (35.35%) vs. 177 (41.94%); 0.0060.81 (0.66-0.99); 0.0390.92 (0.76-1.10); 0.3590.74 (0.59 - 0.93); 0.009
Tac (n = 32,032) vs. Bela (n = 1068)
13821 (43.15) vs 538 (50.37); <0.0010.87 (0.73 - 1.04); 0.1390.99 (0.84-1.16); 0.9040.85 (0.69 - 1.04); 0.108