{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:58:44Z","timestamp":1791388724824,"version":"4.3.3"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"\n Background.<\/jats:title>\n It is unclear whether kidney grafts from deceased donors with acute kidney injury (AKI) are more vulnerable to calcineurin inhibitor nephrotoxicity, and whether de novo use of belatacept is more beneficial than tacrolimus for recipients of these types of kidney transplants.<\/jats:p>\n <\/jats:sec>\n \n Methods.<\/jats:title>\n In this retrospective cohort study using the US Organ Procurement and Transplantation Network database, we created 1:4 matches with highly similar characteristics for recipients of AKI-donor kidneys receiving belatacept versus tacrolimus for initial maintenance immunosuppression and compared outcomes for graft function, patient and graft survival, and rejection.<\/jats:p>\n <\/jats:sec>\n \n Results.<\/jats:title>\n The matched cohort consisted of 567 and 2268 recipients administered belatacept and tacrolimus, respectively. Posttransplant estimated glomerular filtration rate was significantly higher in the belatacept group at 6 mo (58.2\u2005\u00b1\u200524.2 versus 54.6\u2005\u00b1\u200521.6\u2009mL\/min\/1.73 m2<\/jats:sup>, P<\/jats:italic>\u2005<\u20050.001); however, the between-group difference did not reach statistical significance at 12 mo (57.2\u2005\u00b1\u200524.3 versus 55.7\u2005\u00b1\u200522.2\u2009mL\/min\/1.73 m2<\/jats:sup>, P<\/jats:italic>\u2005=\u20050.057). Median follow-up periods were 3.2 and 3.1 y for patient and graft survival, respectively. There were no significant differences between belatacept versus tacrolimus for mortality (hazard ratio 1.18 [95% confidence interval, 0.95-1.47], P<\/jats:italic>\u2005=\u20050.14) or death-censored graft failure (hazard ratio 1.17 [0.85-1.61], P<\/jats:italic>\u2005=\u20050.33). Rejection rate within 12 mo was significantly higher in the belatacept group (13% versus 7%, P<\/jats:italic>\u2005<\u20050.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusions.<\/jats:title>\n In this matched cohort study, initial use of belatacept for AKI-donor kidney recipients was associated with small benefits in early graft function when compared with tacrolimus. Although rejection risk was significantly higher in recipients administered belatacept, patient and graft survival were not significantly different between groups.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/tp.0000000000005196","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T20:03:16Z","timestamp":1725480196000},"page":"691-700","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Belatacept Versus Tacrolimus for Kidney Transplant Recipients of Deceased Donors With Acute Kidney Injury: US National Database Study"],"prefix":"10.1097","volume":"109","author":[{"given":"Junji","family":"Yamauchi","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT."},{"name":"Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan."},{"name":"Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Raghavan","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duha","family":"Jweehan","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suayp","family":"Oygen","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silviana","family":"Marineci","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac E.","family":"Hall","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miklos Z.","family":"Molnar","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,9,4]]},"reference":[{"key":"R1-20250325","doi-asserted-by":"crossref","first-page":"2842","DOI":"10.1111\/ajt.17167","article-title":"Influence of organ quality on the observed association between deceased donor kidney procurement biopsy findings and graft survival.","volume":"22","author":"Husain","year":"2022","journal-title":"Am J Transplant"},{"key":"R2-20250325","doi-asserted-by":"crossref","first-page":"2562","DOI":"10.1056\/NEJMoa067411","article-title":"Reduced exposure to calcineurin inhibitors in renal transplantation.","volume":"357","author":"Ekberg","year":"2007","journal-title":"N Engl J Med"},{"key":"R3-20250325","doi-asserted-by":"crossref","first-page":"481","DOI":"10.2215\/CJN.04800908","article-title":"Calcineurin inhibitor nephrotoxicity.","volume":"4","author":"Naesens","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"R4-20250325","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/aor.13551","article-title":"Tacrolimus: 20 years of use in adult kidney transplantation. 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