<h3>Introduction</h3> Belatacept is a selective costimulatory blocker approved for immunosuppression after kidney transplantation. Data for its use in other solid organ transplants shows mixed results. We present 3 cases of its efficacy in lung transplant as an alternative agent for maintenance therapy in unique contexts. <h3>Case Report</h3> Patient #1 is a 40 year old male who received bilateral lung transplant for ILD from scleroderma complicated by AKI requiring hemodialysis with partial renal recovery at discharge. Over the next 7 months, his renal function declined and with a creatinine of 3.9 mg/dL, belatacept was initiated in combination with a lowered tacrolimus goal of 5 - 6 ng/mL to minimize further nephrotoxicity. 2 months into this course, his creatinine improved to 3.2 mg/dL without untoward effect on the allograft. Patient #2 is a 47 year old female who underwent a third retransplant for CLAD. Prior to the third transplant, her immunosuppression consisted of sirolimus, tacrolimus, and prednisone. Mycophenolate mofetil was avoided due to prior skin cancer. Given her history of rejection and high PRA, she was started on belatacept to supplement tacrolimus and prednisone post-op. 22 months post-transplant she has low level DSA and normal cfDNA levels with a normally functioning graft. Patient #3 is a 66 year old male with a right lung transplant for IPF. His course was complicated by TTP and HUS secondary to calcineurin inhibitors, which reoccurred on rechallenge with mTOR inhibitors. He was subsequently started on belatacept along with mycophenolate mofetil and prednisone. He has been on this regimen for 2 years without recurrent side effects, cytopenia, or renal dysfunction. <h3>Summary</h3> Belatacept is renal sparing, which is beneficial as standard immunosuppression regimens include calcineurin inhibitors that are nephrotoxic. Its utility to prevent rejection was shown when evaluated by DSA and cfDNA levels. In the rare case of TTP and HUS, these phenomena did not reoccur. It is imperative to recognize the risks with this agent. PTLD has occurred in EBV-seronegative recipients. There has been an association of viral infections, including CMV. ACR has been documented in heart and kidney recipients. In conclusion, belatacept has a role as an alternative immunosuppressive component in the appropriate clinical context.