Purpose of Review <p>Immunosuppressive regimens in kidney transplant are largely still reliant on steroids and calcineurin inhibitors (CNIs) despite long-term side effects and nephrotoxicity. Belatacept is a costimulatory blockade molecule which has been shown to improve GFR and metabolic parameters though has been associated with increased rates of acute rejection, limiting its widespread use. This review details the historical development of belatacept, describes the iterative refinement of de novo and conversion protocols utilizing belatacept, summarizes current trends in its use, and discusses its ongoing development in future applications.</p> Recent Findings <p>Belatacept use continues to widen. Gradual refinements to protocols have reduced the incidence of acute rejection to rates comparable to those seen in CNI-based regimens. Increasingly varied combinations with mTOR inhibition, depletional induction, low-dose CNIs, and emerging targeted monoclonal antibody therapies continues to expand the possible uses for belatacept as safe, effective, and durable immunosuppression.</p> Summary <p>Belatacept provides significant advantages when used as immunosuppression in kidney transplantation, allowing minimization of the negative effects of steroids and CNIs; increasingly creative combinations with standard and emerging medications continues to widen its use and allow increasing access.</p>