2026 Eastern States Conference

Authors: Seo Young Chun, PharmD; Melissa Chaung, PharmD, BCPS; Michael A. Wynd, PharmD, BCPS

Learning Objective: At the conclusion of my presentation, the audience will be able to compare the allograft function outcomes of early vs late conversion from tacrolimus to belatacept in kidney transplant recipients. 

Background/Objective:
Assess the impact of timing of conversion from tacrolimus to belatacept on allograft function in kidney transplant recipients (KTRs).

Methods:
This was a single-center, retrospective cohort study evaluating first kidney-alone, adult (age ≥ 18 years at the time of conversion), Epstein-Barr virus IgG seropositive KTRs who converted from tacrolimus to belatacept between January 1, 2013, and December 31, 2024. Recipients of multi-organ transplants or patients receiving belatacept for < 30 days were excluded. Outcomes at 1-year post-conversion were compared between KTRs who converted early (< 6 months post-transplant) vs late (≥ 6 months post-transplant). The primary endpoint was the change in estimated glomerular filtration rate from baseline. Secondary endpoints included patient and allograft survival, biopsy-proven acute rejection, opportunistic viral infections, malignancy, discontinuation-rate of belatacept, and adverse events. Demographic data, within-cohort, and between-cohort comparisons were analyzed using appropriate statistics.

Results:
Of 177 patients screened, 76 patients were included, with 67 patients in the early conversion group and 9 patients in the late conversion group. Baseline demographics were similar between groups, although pre-transplant donor-specific antibodies were more common in the late conversion group (44.4% vs 11.9% [p = 0.04]). Median eGFR at conversion was lower in the early conversion group compared to the late conversion group (20 vs 45 mL/min/1.73m2 [p = 0.01]). At 1 year post-conversion, the early conversion group demonstrated a greater change in eGFR (23 vs 7 mL/min/1.73m2 [p = 0.0083]). No significant differences were observed in patient and allograft survival, rejection, opportunistic infections, and belatacept discontinuation between groups. 

Conclusion:
Early conversion from tacrolimus to belatacept was associated with greater improvement in eGFR, likely reflecting lower baseline eGFR and greater opportunity for recovery at the time of conversion. While interpretation is limited by the disproportionately smaller late conversion cohort, this study provides descriptive real-world data on institutional belatacept conversion practices and outcomes across different conversion strategies.

Self-Assessment Questions:
Which of the following is a common reason for patients to convert from tacrolimus to belatacept?

1. Nephrotoxicity
2. Gastrointestinal side effects
3. Neurotoxicity
4. All of the above