According to an editorial, barriers exist to more widespread adoption of belatacept, as many patients are reluctant to undergo a monthly infusion, particularly those previously on dialysis, whose IV access may be compromised; and it is significantly more expensive than tacrolimus. However no monitoring of drug levels is necessary with belatacept. The commentators note the need to define how best to combine belatacept with other available immunosuppressive agents to lower the risk of rejection mediated by memory T cells that are resistant to costimulatory blockade. In addition, head-to-head comparisons of belatacept with tacrolimus are needed, since this drug is associated with better graft survival than cyclosporine. More information is also needed about belatacept in paediatric populations, patients at risk for recurrent glomerulonephritis, and sensitised patients with high levels of preformed anti-HLA antibodies, who were excluded from BENEFIT.