Belatacept in Renal Transplantation With Intermediate Risk Maryland Aggregate Pathology Index (MAPI) Scores

Inclusion criteria

• Male or female renal recipients 18-70 years of age undergoing primary kidney transplantation.
• Recipients of deceased donor (including expanded criteria donor organs and deceased donor organs after cardiac death) with MAPI score ≥ 8.
• Cold ischemic time less than 40 hours at time of reperfusion.
• Negative serum pregnancy test for female patients.
• Patients who can understand the purposes and risks of the study, provide informed consent, and can comply with the treatment and follow-up requirements.

Exclusion criteria

• Cold ischemic time (CIT) > 40 hours
• Patients who are sensitized with current PRA>40%, ABO incompatible transplants, or T, or B cell crossmatch positive transplant.
• Patients without antibody to EBV
• Patients receiving multiple organ transplants.
• Patients unable to take oral medication at time of randomization
• Patient with a history of malignancy of any organ system, treated or untreated, within the past 2 years whether or not there is evidence of local recurrence or metastases, with the exception of carcinoma in situ
• Patients who tested positive for HIV, Hepatitis C or Hepatitis B surface antigen.
• Recipients of organs from donors who test positive for HIV, Hepatitis C or Hepatitis B surface antigen
• Patients with a clinically significant systemic infection within 30 days prior to transplant
• Patients who have cardiac failure at time of screening or any other severe cardiac disease as determined by the investigator
• Patients with abnormal laboratory findings of clinical significance within 2 weeks of randomization which would interfere with the objectives of the study.
• Females, pregnant or lactating, or are of childbearing potential unwilling to use an effective means of contraception or are planning to become pregnant.
• Patient with active tuberculosis infection