{
  "abstract": "Background\n\nCalcineurin inhibitor (CNI) nephrotoxicity drives long-term kidney-function decline after simultaneous pancreas-kidney (SPK) and liver-kidney (LK) transplantation, but belatacept conversion, as an alternative strategy, is poorly studied in these recipients, whose non-kidney allograft rejection risk differs.Methods\n\nWe retrospectively studied six SPK and six LK recipients converted from CNI- to belatacept-based immunosuppression and analyzed the cohorts separately alongside a narrative review of published SPK/LK conversion experiences. Outcomes were estimated glomerular filtration rate (eGFR) trajectories and slopes, donor-specific antibodies (DSA) and rejection, pancreatic, hepatic and metabolic parameters, infections, and survival, reported descriptively with exploratory estimates and 95% confidence intervals (CI).Results\n\nConversion occurred a median of 64 (SPK) and 89 (LK) months after transplantation, always with a transient low-dose CNI overlap (target trough 3-4 ng/ml). In SPK recipients, median eGFR rose from 45.4 to 55.5 mL/min/1.73m² and the median eGFR slope changed from -3.9 to +5.6 mL/min/year (mixed-model slope change +12.6, 95% CI 2.9 to 22.3); in LK recipients, from 38.8 to 46.3 and from -3.1 to +4.1 (estimate +6.3, 95% CI -4.2 to 16.7). No new DSA developed; pre-existing DSA declined or remained stable. Pancreatic and liver function stayed stable. Two infections in LK recipients (Pneumocystis pneumonia, adenovirus) were possibly belatacept-aggravated. Over a median 25 months, 8/12 (67%) remained on belatacept.Conclusions\n\nLate belatacept conversion with a transient low-dose CNI overlap was feasible in selected SPK and LK recipients and was associated with stable-to-improved kidney function without a pancreatic or hepatic safety signal. The uncontrolled design supports feasibility, not efficacy.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Nephrology, University Hospital Zurich, Zurich, Switzerland.",
    "Division of Nephrology, Cantonal Hospital Lucerne, Lucerne, Switzerland.",
    "Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Dusan Harmacek"
    },
    {
      "affs": [
        0
      ],
      "name": "Elena Rho"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Seraina von Moos"
    },
    {
      "affs": [
        0
      ],
      "name": "Severin Simmler"
    },
    {
      "affs": [
        0
      ],
      "name": "Thomas Welte"
    },
    {
      "affs": [
        2
      ],
      "name": "Fabian Rössler"
    },
    {
      "affs": [
        0
      ],
      "name": "Thomas Schachtner"
    },
    {
      "affs": [
        0
      ],
      "name": "Lukas Weidmann"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c0crd8qxnwpen.bib",
  "cited_by": 0,
  "doi": "10.1111/ctr.70719",
  "fulltext_url": "https://europepmc.org/articles/PMC13677084",
  "id": "c0crd8qxnwpen",
  "issns": [
    "0902-0063",
    "1399-0012"
  ],
  "landing_url": "https://europepmc.org/article/MED/42893532",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2747|Renal Transplantation Outcomes and Treatments"
    ]
  ],
  "openalex": "W7222884475",
  "pdf_url": "https://europepmc.org/articles/PMC13677084?pdf=render",
  "pmcid": "PMC13677084",
  "pmid": "42893532",
  "published": "2026-10-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/c0crd8qxnwpen.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:00Z",
      "native_id": "MED:42893532",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42893532"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2747|Renal Transplantation Outcomes and Treatments",
      "subfield": "surgery"
    }
  ],
  "title": "Belatacept Conversion in Simultaneous Pancreas-Kidney and Liver-Kidney Transplant Recipients: A Single-Center Feasibility Cohort and Narrative Review.",
  "title_text": "Belatacept Conversion in Simultaneous Pancreas-Kidney and Liver-Kidney Transplant Recipients: A Single-Center Feasibility Cohort and Narrative Review.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:00Z",
  "url": "https://research.draconitic.com/paper/c0crd8qxnwpen",
  "venue": "Clinical transplantation",
  "versions": []
}