{
  "abstract": "Background and Importance Calcineurin inhibitor (CNI) toxicity remains a major cause of chronic graft dysfunction and loss after kidney transplantation. Belatacept provides an alternative immunosuppressive strategy without direct nephrotoxicity. However, its use is restricted in our country as it is not currently funded by the national health system. A multidisciplinary protocol for belatacept use in kidney transplant recipients was approved by Nephrology and Pharmacy departments to select appropriate patients for treatment. Real-world evidence in this context is limited in Europe, especially under non-funded conditions.Aim and Objectives To describe patient characteristics, indications for conversion, persistence, graft and patient survival at 12 months, and safety outcomes in kidney transplant recipients converted from tacrolimus to belatacept in clinical practice.Material and Methods Retrospective, single-centre, observational study (February 2019–June 2025). All Epstein–Barr virus (EBV)-positive adult kidney transplant recipients converted from tacrolimus to belatacept were included. Data collected: demographics, number of transplants, donor characteristics, cold ischaemia time, time to conversion, reason for conversion, graft and patient survival (12 months and last follow-up), discontinuation and safety. Descriptive analysis was performed using standard statistical methods.Results Twenty-four patients were included (n=14 male; mean age 57 years). Most were first transplants (n=20/24) and received kidneys from expanded-criteria donors (n=10/24). Median cold ischaemia time was 16 h. Conversion was mostly late (>6 months post-transplant) (n=20/24; median 36 months post-transplant). Main reasons of conversion: CNI-related toxicity or intolerance (n=16), arteriolar hyalinosis (n=5), antibody-mediated rejection (n=3). Sixteen patients had more than 12 months of follow-up. Among them, graft survival was 94% (15/16) and two patient deaths. Belatacept persistence was 67% (n=16/24). Discontinuations occurred due to graft failure (n=4), rejection (n=2), or death (n=2). No adverse events attributable to belatacept were reported.Conclusion and Relevance In a non-funded national setting, conversion from tacrolimus to belatacept under a multidisciplinary protocol was feasible and safe, achieving high graft and patient survival and good tolerability. Despite the small sample, this experience provides valuable real-world evidence supporting belatacept as a rescue strategy after CNI intolerance. Multicentre studies are warranted to confirm these findings and guide implementation in similar healthcare systems.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Son Espases Universitary Hospital, Department of Pharmacy, Palma De Mallorca, Spain"
      ],
      "name": "RA Freites Nava"
    },
    {
      "affiliations": [
        "Son Espases Universitary Hospital, Department of Pharmacy, Palma De Mallorca, Spain"
      ],
      "name": "G Arrufat Goterris"
    },
    {
      "affiliations": [
        "Son Espases Universitary Hospital, Department of Nephrology, Palma De Mallorca, Spain"
      ],
      "name": "S Cabello Pelegrin"
    },
    {
      "affiliations": [
        "Son Espases Universitary Hospital, Department of Nephrology, Palma De Mallorca, Spain"
      ],
      "name": "ZJ De Zarate Lupgens"
    },
    {
      "affiliations": [
        "Son Espases Universitary Hospital, Department of Nephrology, Palma De Mallorca, Spain"
      ],
      "name": "EM Gonzalez Perez"
    },
    {
      "affiliations": [
        "Son Espases Universitary Hospital, Department of Pharmacy, Palma De Mallorca, Spain"
      ],
      "name": "T Garcia Ruiz"
    },
    {
      "affiliations": [
        "Son Espases Universitary Hospital, Department of Pharmacy, Palma De Mallorca, Spain"
      ],
      "name": "D Galindo San Segundo"
    },
    {
      "affiliations": [
        "Son Espases Universitary Hospital, Department of Pharmacy, Palma De Mallorca, Spain"
      ],
      "name": "M Aguasca Adrover"
    },
    {
      "affiliations": [
        "Son Espases Universitary Hospital, Department of Pharmacy, Palma De Mallorca, Spain"
      ],
      "name": "C Martorell Puigserver"
    }
  ],
  "title": "4CPS-287 Conversion from tacrolimus to belatacept in kidney transplant recipients: real-world outcomes from a retrospective observational study",
  "uid": "f84a336f-2518-54d7-b1d1-7b497738b9d7"
}