title: Belatacept conversion in African American kidney transplant recipients with severe renal dysfunction.
abstract: OBJECTIVE
  Conversion from calcineurin inhibitor-based maintenance immunosuppression to belatacept in kidney transplant recipients has been demonstrated to improve renal function while maintaining efficacy against rejection. However, conversion studies to date have excluded patients with an estimated glomerular filtration rate < 35 mL/min/1.73 m2.
  
  
  METHODS
  We describe two patients with an estimated glomerular filtration rate < 30 mL/min/1.73 m2who underwent conversion from maintenance calcineurin inhibitor to belatacept.
  
  
  RESULTS
  Both patients experienced improvement in renal function following conversion.
  
  
  CONCLUSIONS
  These results suggest that patients with more severe degrees of allograft impairment may benefit from conversion of maintenance calcineurin inhibitor to belatacept-based immunosuppression. Larger, randomized studies are warranted to evaluate the impact of such an approach.
authors.affiliation: Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA; College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Snyder
authors.affiliation: Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA; College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Duhart
authors.affiliation: Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA; College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Amy G
authors.initials: AG
authors.lastname: Krauss
authors.affiliation: Methodist University Hospital Transplant Institute and University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Vinaya
authors.initials: V
authors.lastname: Rao
keywords: Belatacept; calcineurin inhibitor nephrotoxicity; kidney transplantation