Belatacept‐Based Immunosuppression and Donor‐Specific Antibodies in Lung Transplant: A Multi‐Institutional Retrospective Study

Background Belatacept use in renal transplant is associated with similar graft survival and elimination of preexisting donor‐specific antibodies (DSA). We aim to describe the impact of Belatacept use on de novo DSA in lung transplant (LTx). Methods A multi‐institutional retrospective review of LTx patients with de novo DSA who received Belatacept (January 2018–August 2023) was performed. The primary outcome is the change in DSA post Belatacept initiation. Changes in mean fluorescence intensity (MFI) before and after Belatacept administration were analyzed using a linear mixed‐effects model. Secondary outcomes included antibody‐mediated rejection (AMR). Results Forty‐four patients with DSA received Belatacept. Most DSA were class II ( n = 41, 93%), with a median (IQR) MFI of 4000 (2500–7000) at Belatacept initiation. Following Belatacept initiation, DSA resolved in ( n = 25, 57%) patients, decreased in ( n = 7, 16%), and remained unchanged in ( n = 12, 27%). No de novo DSA developed during Belatacept therapy. There was no significant change in MFI pre Belatacept administration (change = −38, 95% CI: −267 to 191, p = 0.745), whereas MFI decreased significantly post Belatacept administration (change = −334, 95% CI: −449 to −219, p < 0.001). A total of ( n = 25, 57%) patients experienced AMR prior to initiating Belatacept. None of the patients developed AMR while on Belatacept. Conclusion This is the largest cohort to date of LTx patients with DSA who received Belatacept. Belatacept use was associated with a reduction in DSA.