Comparing Outcomes between Alemtuzumab and Non-Alemtuzumab Induction in Kidney Allograft Recipients

Introduction: We report our experiences with induction agents for kidney allograft recipients from 2004 to 2010. Alemtuzumab-induced patients received tacrolimus and MMF for maintenance immunosuppression. Non-Alemtuzumab induced patients were maintained on tacrolimus, MMF, and prednisone. Methods: From 2004 to 2010, 809 patients received kidney allografts at Washington Hospital Center. After excluding simultaneous pancreas-kidney (SPK), Hepatitis C, Human T-Lymphotropic Virus (HTLV), and Human Immunodeficiency Virus (HIV) patients, we identified 88 patients who received non-Alemtuzumab induction-thymoglobulin, basiliximab, or daclizumab for various reasons, mostly surgeon preference. These 88 non-Alemtuzumab-induced patients were matched to an equal number of patients by age, gender, race, donor type, and primary diagnosis who received a single 30 mg dose of Alemtuzumab intraoperatively. Patient and graft survival, and incidence of rejection and infection events were compared.Table: [Demographics]Table: [Results]Results: Both cohorts had similar outcomes for patient and graft survival as well as infection rates. The biopsy-proven rejection was numerically, but not statistically higher in the non-Alemtuzumab cohort. Mean serum creatinine (SCr) was similar in both groups throughout the time intervals. The mean White Blood Cell Count (WBC) count was lower in the prednisone free Alemtuzumab group at all time points. The median follow-up time for the Alemtuzumab group was 19 months compared to the non-Alemtuzumab group of 22 months. Conclusion: Alemtuzumab induction was safe and effective, with a similar rate of infections, graft and patient survival, but a numerically lower rate of rejection.