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To date, no large studies have compared belatacept directly with tacrolimus after T\u2010cell depleting induction in renal transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Standard Transplant Analysis and Research file was used to compare adult kidney transplant recipients induced with T\u2010cell depleting agents treated with belatacept to propensity score\u2010matched recipients treated with tacrolimus between August 10, 2011 and June 29, 2023. Kaplan\u2013Meier survival analysis was used to compare death censored graft survival, patient survival, and time to acute rejection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period, 4391 adult kidney transplant recipients were treated with belatacept. Estimated GFR improved for belatacept\u2010treated patients through year 9, whereas it decreased for the control group through year 10. Belatacept\u2010treated patients had a higher rejection rate at 5 years (21%\u00a0vs. 15%, <jats:italic>p<\/jats:italic> &lt;\u00a00.001). Death\u2010censored graft survival did not differ between groups (<jats:italic>p<\/jats:italic> = 0.383). Among patients who had rejection, death\u2010censored graft survival was superior in belatacept\u2010treated patients at 5 years (70%\u00a0vs. 60%, <jats:italic>p<\/jats:italic> = 0.026). Overall, patient survival did not differ between groups (<jats:italic>p<\/jats:italic> = 0.120).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This is the largest longitudinal study to compare outcomes of belatacept versus tacrolimus\u2010based therapy following T\u2010cell depleting induction. Belatacept was associated with improved graft function despite an increased acute rejection rate. There was no difference in overall graft or patient survival compared to tacrolimus. This study suggests that belatacept\u2010based therapy is not inferior to tacrolimus\u2010based therapy following T\u2010cell depletion.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.70154","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T16:23:56Z","timestamp":1744734236000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Long\u2010Term Outcomes of Belatacept Versus Tacrolimus Following T\u2010Cell Depleting Induction in Adult Kidney Transplantation"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3625-1392","authenticated-orcid":false,"given":"Laura E.","family":"Newton","sequence":"first","affiliation":[{"name":"Department of General Surgery Dartmouth Health  Lebanon New Hampshire USA"},{"name":"Department of Surgery Veterans Affairs Medical Center  White River Junction Vermont USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8330-4436","authenticated-orcid":false,"given":"Thomas W.","family":"D'Angelo","sequence":"additional","affiliation":[{"name":"Tuck School of Business at Dartmouth  Hanover New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5608-0972","authenticated-orcid":false,"given":"Michael C.","family":"Chobanian","sequence":"additional","affiliation":[{"name":"Department of Solid Organ Transplantation Dartmouth Health, Lebanon  New Hampshire USA"},{"name":"Geisel School of Medicine at Dartmouth  Hanover New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3733-2530","authenticated-orcid":false,"given":"Michael F.","family":"Daily","sequence":"additional","affiliation":[{"name":"Department of Solid Organ Transplantation Dartmouth Health, Lebanon  New Hampshire USA"},{"name":"Geisel School of Medicine at Dartmouth  Hanover New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8135-8458","authenticated-orcid":false,"given":"Asha M.","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Department of Solid Organ Transplantation Dartmouth Health, Lebanon  New Hampshire USA"},{"name":"Geisel School of Medicine at Dartmouth  Hanover New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Larkin.OPTN\/SRTR 2021 Annual Data Report.2021."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejm198409133111103"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1990.03450010067032"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478\u2010199301000\u201000007"},{"key":"e_1_2_11_6_1","unstructured":"United States Renal Data System.USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End\u2010Stage Renal Disease in the United States;2008."},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000160764.35083.B8"},{"key":"e_1_2_11_8_1","unstructured":"S. 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