Kidney Week

Abstract: SA-PO1175

Belatacept Conversion for Delayed Graft Function After Kidney Transplantation: A Systematic Review and Meta-Analysis

Session Information

• Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Hih, Nouraldin, Mansoura University, Mansoura, Dakahlia Governorate, Egypt

Nouraldin Hih, MBBS

• Soliman, Abdelsalam Karim, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States

Abdelsalam Karim Soliman

• Randhawa, Parmjeet S., University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States

Parmjeet S. Randhawa, MD, MBBS

• Puttarajappa, Chethan M., University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States

Chethan M. Puttarajappa, MD, MS

• Tevar, Amit D., University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States

Amit D. Tevar, MD

• Soliman, Karim, UPMC, Pittsburgh, Pennsylvania, United States

Karim Soliman, MBChB, MSc, PhD, FASN

Background

Delayed graft function (DGF) after kidney transplantation is associated with poor allograft outcomes, and prolonged calcineurin inhibitor (CNI) exposure may worsen ischemia-reperfusion injury and nephrotoxicity. Early tacrolimus-to-belatacept conversion may facilitate renal recovery by eliminating CNI nephrotoxicity and vasoconstriction. We conducted a systematic review and meta-analysis to evaluate renal and clinical outcomes of belatacept conversion in kidney transplant recipients with prolonged DGF or severe early allograft dysfunction.

Methods

A systematic review identified observational studies evaluating belatacept conversion after kidney transplantation for DGF or CNI nephrotoxicity. The primary outcome was change in eGFR at ~12 months post-conversion. Secondary outcomes included acute rejection, graft loss, mortality, de novo DSA, and infectious complications. Pre-specified subgroup analysis by conversion timing (early <=90 days vs late/mixed) explored heterogeneity. Random-effects meta-analysis was performed using inverse variance weighting.

Results

Five studies (n=326) were included; four (n=320) meta-analysed, one case series (n=4) narratively synthesised. Belatacept conversion improved eGFR at ~12 months (MD +19.02 mL/min/1.73 m2, 95% CI 10.24-27.80, p<0.0001, I2=85%); sensitivity analysis yielded a larger homogeneous effect (MD +22.34, 95% CI 17.30-27.39, I2=0%). Early conversion (<=90 days; n=45) showed homogeneous renal recovery (MD +20.42, 95% CI 14.43-26.42, I2=0%); late/mixed cohorts (n=275) showed heterogeneous benefit (MD +17.90, 95% CI 1.25-34.56, I2=91%). Acute rejection incidence in DGF cohorts (n=83) was 14.5% (95% CI 1.9-27.1%, I2=64%). In the largest matched cohort (Divard 2024; n=486), rejection rates were comparable to CNI controls; 7-year graft survival favored belatacept (78% vs 63%, p<0.001). De novo DSA was lower (10% vs 21%, p=0.002); proteinuria more frequent (37% vs 21%, p<0.001).

Conclusion

Early belatacept conversion in kidney transplant recipients with prolonged DGF or severe allograft dysfunction was associated with clinically meaningful improvements in eGFR, acceptable rejection risk, improved graft survival, and favorable immunologic outcomes. Benefit appeared most consistent among early-conversion cohorts. Prospective studies are needed to define optimal conversion timing and long-term outcomes.

Acknowledgment

None