Belatacept in Renal Transplantation With Intermediate Risk Maryland Aggregate Pathology Index (MAPI) Scores

Inclusion Criteria: * Male or female renal recipients 18-70 years of age undergoing primary kidney transplantation. * Recipients of deceased donor (including expanded criteria donor organs and deceased donor organs after cardiac death) with MAPI score ≥ 8. * Cold ischemic time less than 40 hours at time of reperfusion. * Negative serum pregnancy test for female patients. * Patients who can understand the purposes and risks of the study, provide informed consent, and can comply with the treatment and follow-up requirements. Exclusion Criteria: * Cold ischemic time (CIT) \> 40 hours * Patients who are sensitized with current PRA\>40%, ABO incompatible transplants, or T, or B cell crossmatch positive transplant. * Patients without antibody to EBV * Patients receiving multiple organ transplants. * Patients unable to take oral medication at time of randomization * Patient with a history of malignancy of any organ system, treated or untreated, within the past 2 years whether or not there is evidence of local recurrence or metastases, with the exception of carcinoma in situ * Patients who tested positive for HIV, Hepatitis C or Hepatitis B surface antigen. * Recipients of organs from donors who test positive for HIV, Hepatitis C or Hepatitis B surface antigen * Patients with a clinically significant systemic infection within 30 days prior to transplant * Patients who have cardiac failure at time of screening or any other severe cardiac disease as determined by the investigator * Patients with abnormal laboratory findings of clinical significance within 2 weeks of randomization which would interfere with the objectives of the study. * Females, pregnant or lactating, or are of childbearing potential unwilling to use an effective means of contraception or are planning to become pregnant. * Patient with active tuberculosis infection