{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:54:45Z","timestamp":1781758485385,"version":"3.54.5"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    We conducted a retrospective review of adult kidney transplant recipients (KTRs) who received belatacept in addition to calcineurin inhibitors, antimetabolites, and corticosteroids for recurrent or refractory rejection or for persistent donor-specific antibodies (DSAs) unresponsive to standard therapy. Fifteen recipients were included. Kidney function remained stable on follow-up; median eGFR was 52 mL\/min (R 23\u201391) at baseline and 54 mL\/min (R 25\u2013105) at 6 months (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.15) after belatacept initiation. The DSA intensity declined significantly from a median of 4,990 mean fluorescence intensity (MFI) (R 0\u201323,305) at baseline to 1,644 MFI (R 0\u20136,903) at 3\u20136 months (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.03). There was also a small reduction in biopsy-proven rejections from 85.7% to 63.6%. Infections occurred in most recipients (73.3%), with a majority arising more than 6 months after therapy initiation. Two patients developed post-transplant lymphoproliferative disorder (PTLD), each with either substantial prior exposure to lymphocyte-depleting agents or prolonged immunosuppression. Two deaths occurred, one related to PTLD and one to septic shock. These findings suggest that belatacept-based quadruple immunosuppression may reduce DSA and stabilize kidney function in patients with persistent alloimmunity, but without a statistically significant reduction in rejections. There is also a significant burden of infections and PTLD, highlighting the need for careful patient selection and caution before adopting this approach.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1844666","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:35:29Z","timestamp":1781757329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of belatacept-based quadruple immunosuppression therapy in kidney transplant recipients with persistent alloimmune response: a single-center observational study"],"prefix":"10.3389","volume":"17","author":[{"given":"Basheer Ahamad","family":"Kummangal","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Oregon Health and Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Olyaei","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Oregon Health and Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"de Mattos","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Oregon Health and Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shehzad","family":"Rehman","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Oregon Health and Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Oregon Health and Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Stack","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Oregon Health and Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoha","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Oregon Health and Science University","place":["Portland, OR, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Pandav","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Oregon Health and Science University","place":["Portland, OR, United 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