Belatacept in liver transplantation: Results of a national survey among French specialists.

BACKGROUND: Belatacept has been approved and widely used for around ten years to prevent acute rejection after kidney transplantation. Its use in liver transplantation (LT) remains anecdotal. The objective of this study was to evaluate the current/potential use of belatacept in France in the context of LT, using an online survey. METHODS: An online survey comprising 23 questions was sent in June 2025 to 100 specialists in adult LT. RESULTS: The 26 respondents rated their level of knowledge about belatacept as good (15.4%), partial (61.5%) or poor (23.1%). They had used belatacept in 58.1% of cases after liver-kidney transplantation and 15.4% after LT alone. Belatacept was used in de novo (19.2%), early switch (19.2%) and/or late switch (46.2%) settings. In addition, 61.5% believed that belatacept might play a limited role in LT, whereas 38.5% felt it could have a significant role; belatacept could be used in de novo (3.8%), early switch (26.9%) and/or late conversion (88.5%) settings, primarily to minimize (32.0%), or withdraw CNIs (92.0%), either in combination with MMF or mTORi (48.0%), or as monotherapy (8.0%). Half of the respondents felt that belatacept was not associated with prohibitive toxicity risks; 84.6% had already considered using a long-acting injectable immunosuppressant, and 76.9% had encountered patients who had reached a dead end with the standard classes of immunosuppressants. All respondents were willing to participate in a prospective study evaluating belatacept in LT. CONCLUSIONS: Our survey confirms that belatacept is rarely used in LT, but its place deserves to be better evaluated.