Belatacept was introduced as an immunosuppressant for kidney transplantation in 2010, but its use in Spain remains limited. Since its commercialization, 15 kidney transplant recipients have received immunosuppressive treatment with belatacept at the Cruces University Hospital. This observational and retrospective study analyzes the reasons for switching to belatacept, its impact on kidney function, and the drug's safety profile. In all cases, it was used as a maintenance immunosuppressant rather than for induction, and its use was determined by the presence of severe side effects from other immunosuppressants, particularly calcineurin inhibitors. The estimated glomerular filtration rate during the first year increased in patients who had previously experienced nephrotoxicity from calcineurin inhibitors and remained stable in the others, whereas proteinuria improved in patients who had been treated with mammalian target of rapamycin inhibitors. Additionally, no adverse effects clearly related to belatacept were observed. This analysis suggests that belatacept is a safe and well-tolerated drug that does not negatively affect kidney function and may even have a beneficial effect on certain groups of patients. Therefore, it presents a therapeutic alternative to consider in patients with serious contraindications to other treatments.
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