{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T18:39:25Z","timestamp":1792348765321,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Calcineurin inhibitor (CNI) nephrotoxicity drives long\u2010term kidney\u2010function decline after simultaneous pancreas\u2010kidney (SPK) and liver\u2010kidney (LK) transplantation, but belatacept conversion, as an alternative strategy, is poorly studied in these recipients, whose non\u2010kidney allograft rejection risk differs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively studied six SPK and six LK recipients converted from CNI\u2010 to belatacept\u2010based 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\u2010specific antibodies (DSA) and rejection, pancreatic, hepatic and metabolic parameters, infections, and survival, reported descriptively with exploratory estimates and 95% confidence intervals (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Conversion occurred a median of 64 (SPK) and 89 (LK) months after transplantation, always with a transient low\u2010dose CNI overlap (target trough 3\u20104\u00a0ng\/ml). In SPK recipients, median eGFR rose from 45.4 to 55.5\u00a0mL\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      and the median eGFR slope changed from \u22123.9 to +5.6\u00a0mL\/min\/year (mixed\u2010model slope change +12.6, 95% CI 2.9 to 22.3); in LK recipients, from 38.8 to 46.3 and from \u22123.1 to +4.1 (estimate +6.3, 95% CI \u22124.2 to 16.7). No new DSA developed; pre\u2010existing DSA declined or remained stable. Pancreatic and liver function stayed stable. Two infections in LK recipients (\n                      <jats:italic>Pneumocystis<\/jats:italic>\n                      pneumonia, adenovirus) were possibly belatacept\u2010aggravated. Over a median 25 months, 8\/12 (67%) remained on belatacept.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Late belatacept conversion with a transient low\u2010dose CNI overlap was feasible in selected SPK and LK recipients and was associated with stable\u2010to\u2010improved kidney function without a pancreatic or hepatic safety signal. The uncontrolled design supports feasibility, not efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70719","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T17:39:41Z","timestamp":1792345181000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Belatacept Conversion in Simultaneous Pancreas\u2010Kidney and Liver\u2010Kidney Transplant Recipients: A Single\u2010Center Feasibility Cohort and Narrative Review"],"prefix":"10.1111","volume":"40","author":[{"given":"Dusan","family":"Harmacek","sequence":"first","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Rho","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seraina","family":"von Moos","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"},{"name":"Division of Nephrology Cantonal Hospital Lucerne  Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Severin","family":"Simmler","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Welte","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"R\u00f6ssler","sequence":"additional","affiliation":[{"name":"Department of Surgery and Transplantation University Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schachtner","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Weidmann","sequence":"additional","affiliation":[{"name":"Division of Nephrology University Hospital Zurich  Zurich 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