This study evaluated 7-year efficacy and safety outcomes in transplant recipients assigned to a more-intensive or less-intensive belatacept regimen or cyclosporine for immunosuppression. Both belatacept regimens were associated with significantly superior patient and graft survival. The use of prolonged maintenance immunosuppressive therapy after kidney transplantation has improved the short-term outcomes, 1 but the effect on long-term allograft survival is not known. 2 Prospective, phase 3, randomized studies examining the outcomes of immunosuppressive regimens beyond 5 years or showing a survival advantage of newer immunosuppressive regimens over that afforded by regimens containing the calcineurin inhibitor cyclosporine are lacking. 3 – 5 Belatacept is a selective costimulation blocker that has been developed to improve long-term outcomes in kidney-transplant recipients by providing effective immunosuppression without the toxic effects of calcineurin inhibitors. Current standard-of-care immunosuppressive regimens combine calcineurin inhibitors with antiproliferative drugs, with . . .