*PURPOSE: There is some evidence that suggests co-stimulation blockade with bela may impair viral specific immunity and vaccination responses to SARS-CoV-2 (COVID-19). Here we report hospitalization rates for COVID-19 positive kidney transplant receiving bela versus those on CNI based therapy. *METHODS: This retrospective cohort consisted of Southern California Kaiser Permanente kidney transplant recipients with COVID-19 between April 2020-June 2022. Patients were divided into bela and non-bela (CNI based) treatment groups. Baseline variables included age, race, gender, vaccination status, and comorbidities. The primary outcome was hospitalization from COVID-19. Secondary outcomes included death and graft loss. Chi-square was used to assess categorical variables and the Mann Whitney U-test for continuous variables. A multi-variable analysis was conducted using exact logistic regression. A total of 1081 patients were included in the analysis. *RESULTS: Baseline characteristics and vaccination status are shown in Table 1. The bela group had more males and a higher percentage of African-Americans. Significantly more patients in the bela group were hospitalized due to COVID-19 (45% vs. 24%, p< .001). Overall death and graft loss within 90 days of COVID were 10.5% and 1.3% respectively with no significant difference in the two groups. The multivariable analysis demonstrated bela and older age to have an increased risk of hospitalization (Table 2). Third COVID vaccine was shown to be protective for hospitalization compared to those without vaccination. However, bela patients receiving a third COVID vaccine showed similar hospitalization risk as those without vaccination in a multivariable analysis. *CONCLUSIONS: Renal transplant recipeints on bela had a higher risk for hospitalization from COVID-19 regardless of vaccination status. Bela recipients with COVID-19 should be monitored closely and offered available treatments early in the course. One may consider cautious de-escalation of immunosuppression during a COVID infection. A larger sample size is needed to validate the efficacy of vaccination in bela recipients. [

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]CITATION INFORMATION: Chang Z., Li Q., Kahwaji J. Covid-19 Hospitalization Rates for Renal Transplant Recipients on Belatacept (Bela): A Retrospective Study AJT, Volume 23, Issue 6, Supplement 1.

Zubin Chang MD

Kaiser Permanente

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