*Conclusions: In our observational study, conversion from a CNI based regimen to belatacept in elderly renal transplant recipients resulted in improved eGFR. There was a cumulative incidence of 5.7 death-censored graft losses per 100 person-years and 10.3 deaths per 100 person-years. Rejection occurred in 20% of patients at a median of 2 (IQR 1.9-2.7) months post conversion. eGFR significantly improved following belatacept conversion (31 ml/min/1.73m 2 pre vs 42 ml/min/1.73m 2 post p = 0.002). Bacterial infections occurred in 27%, viral in 24%, and fungal in 2% of patients. Thirty-nine percent of patients experienced at least one infection within 6 months of conversion with mean time from conversion to first infection of 1.8 (SD 0.4) months. However, 7.8% of patients experienced other malignancies. There were no instances of transplant lymphoproliferative disorder. ![]() Primary reason for discontinuation was rejection (29%) followed by infection (21%). Discontinuation of belatacept occurred in 27% of patients during follow-up. Conversion was pursued due to desire to improve renal function in 51%, neurotoxicity in 22% and metabolic/cardiovascular concerns in 16% of patients. Mean age at time of conversion was 67 (SD 0.8) years. Median time to conversion was 6.3 (IQR 2.3-20) months post-transplant with median follow-up of 12 (IQR 7-27) months. *Results: Fifty-one patients met inclusion criteria, 86% with CNI withdrawal and 14% with minimization. Secondary endpoints included efficacy defined as change in estimated GFR (eGFR), incidence of rejection, death-censored graft loss and death at last follow-up. Primary objective was to describe our experience with the safety of conversion defined as 6 month incidence of infection and malignancy. ![]() Belatacept conversion was defined as CNI withdrawal or minimization (cyclosporine trough < 75 ng/mL or tacrolimus < 5 ng/mL) following belatacept initiation. *Methods: Adult renal transplant patients aged ≥ 60 years who were converted to belatacept from a CNI between 3/2013-6/2020 were included. *Purpose: Describe the impact of conversion from a calcineurin inhibitor (CNI) based immunosuppressive regimen to belatacept in elderly renal transplant recipients.
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