Tegoprubart beats tacrolimus for kidney preservation in first-transplant trial
In the phase 2 BESTOW trial, the experimental anti-CD40L antibody tegoprubart maintained kidney function better than tacrolimus in adults receiving a first kidney transplant. The kidney-function advantage became statistically significant at 18 months, and patients on tegoprubart also reported larger quality-of-life gains. The results were presented at ASN Kidney Week 2026.
In BESTOW, 127 adults with a first kidney transplant received treatment; 107 reached week 52, including 51 on tegoprubart and 56 on tacrolimus. Graft function leveled off after the first month and stayed higher with tegoprubart at every reported check, reaching statistical significance at 18 months.
At week 52, quality-of-life gains appeared on all five subscales for tegoprubart and four for tacrolimus. Tegoprubart produced a larger mental-component improvement and a numerically greater drop in total symptom score. Tacrolimus, while preventing rejection, can bring kidney toxicity, hypertension, diabetes, tremors, and brain fog.
If confirmed in larger trials, a tacrolimus alternative could affect kidney transplant recipients by reducing burdensome side effects and improving quality of life, while clinicians may gain another immunosuppression option. Health systems could see changes in drug selection and monitoring, though cost, long-term safety, and access remain uncertain. Benefits may extend to other transplant types only if future studies support the CD40L approach.