Alemtuzumab and minimization immunotherapy in kidney transplantation: Long-term results of comparison with rabbit anti-thymocyte globulin and standard triple maintenance therapy

Background Efforts to improve long-term patient and allograft survival have included use of induction therapies as well as steroid and/or calcineurin inhibitor (CNI) avoidance/minimization. Methods This is a retrospective review of kidney transplant recipients between September 2004 and July 2009. Immune minimization (group 1; n = 182) received alemtuzumab induction, low-dose CNI, and mycophenolic acid (MPA). Conventional immunosuppression (group 2; n = 232) received rabbit anti-thymocyte globulin, standard-dose CNI, MPA, and prednisone. Results Both groups were followed up for same length of time (49.4 ± 21.7 months; P =.12). Patient survival was also similar (90% vs 94%; P =.14). Death-censored graft survival was inferior in group 1 compared with group 2 (86% vs 96%, respectively; P =.003). On multivariate analysis, group 1 was an independent risk factor for graft loss (aHR = 2.63; 95% confidence interval [CI], 1.32-5.26; P =.006). Biopsy-proven acute rejection occurred more in group 1, due to late rejections compared with group 2 (7% vs 2%; P <.01 respectively). Graft function was lower in group 1 compared with group 2 at 3 months (49.5 mL/mt vs 70.7 mL/mt, respectively; P <.001) to 48 months (48.6 mL/mt vs 69.4 mL/mt, respectively; P =.04). Conclusion Minimization of maintenance immunosuppression after alemtuzumab correlated with higher acute rejection and inferior graft survival compared with thymoglobulin and conventional triple immunotherapy.