BACKGROUND.:
Alemtuzumab and
rabbit antithymocyte globulin (rATG) are commonly used for induction of immunsuppression for kidney and
pancreas transplantation, but the two agents have not been compared directly. METHODS.: We conducted a prospective randomized single-center trial comparing
alemtuzumab and rATG induction in adult kidney and
pancreas transplantation in patients treated with similar maintenance immunosuppression. RESULTS.: Between February 1, 2005, and September 1, 2007, 222 patients randomly received either
alemtuzumab (n=113) or rATG (n=109) induction; 180 (81%) underwent kidney alone, 38 (17%) simultaneous pancreas-kidney, and 4 (2%) pancreas after kidney transplants. Of 180 kidney-alone transplants, 152 (84%) were from deceased donors, including 61 (34%) from expanded criteria donors. Retransplantation,
human leukocyte antigen match, antibody titer, expanded criteria donors, race, cytomegalovirus status,
delayed graft function, and immunologic risks were similar between the two induction groups. With a median follow-up of 2 years (minimum 1 year), overall patient, kidney, and pancreas graft survival rates were 96%, 89%, and 90%, respectively. Survival, initial
length of stay, and maintenance immunosuppression (including early
steroid elimination) were similar between
alemtuzumab and rATG groups, but biopsy-proven acute rejection (BPAR) episodes occurred in 16 (14%)
alemtuzumab patients compared with 28 (26%) rATG patients (P=0.02). Late BPAR (>12 months after transplant) occurred in 1 (8%)
alemtuzumab patient and 3 (11%) rATG patients (P=NS).
Infections and
malignancy were similar between the two induction arms. CONCLUSION.:
Alemtuzumab and rATG induction
therapies were equally safe, but
alemtuzumab was associated with less BPAR.