Alemtuzumab as compared to alternative contemporary induction regimens

Abstract

Between 1/1/02 and 12/31/07, our center performed 1687 adult renal transplants. A retrospective analysis was performed to compare outcomes between patients receiving alemtuzumab (n=632) and those receiving either basiliximab (n=690) or thymoglobulin (n=125). Patients receiving alemtuzumab were younger (49 vs. 51 years, p=0.02), had fewer HLA matches (1.7 vs. 2.0, p<0.0001), were more likely to have a CMV donor(+)/recipient(−) transplant (22% vs. 17%, p=0.03) and were less likely to receive a living donor allograft (32% vs. 37%, p=0.04). Alemtuzumab recipients were less likely to receive tacrolimus (35% vs. 47%, p<0.0001). The 1-, 3-, and 5-year cumulative incidence of antibody-mediated rejection (AMR) in alemtuzumab-treated patients was 19%, 24%, and 27%, versus 11%, 15%, and 18% for the other group (p<0.0001). The 1-, 3-, and 5-year allograft survival in the alemtuzumab group was 88%, 75%, and 67%, versus 91%, 82%, and 74% for the other group (p<0.0001). Patient survival was equivalent. Alemtuzumab was an independent risk factor for living donor allograft loss (HR 2.0, p=0.004), opportunistic infections (HR 1.3, p=0.01), CMV infections (HR 1.6, p=0.001), and AMR (HR 1.5, p=0.002). The significantly worse graft survival in the alemtuzumab cohort may be due to the increased rates of AMR and infectious complications.