Alemtuzumab Induction in Septuagenarians Undergoing Deceased Donor Kidney Transplantation

INTRODUCTION: The anti-CD52 monoclonal antibody alemtuzumab is used as an induction agent in kidney transplantation (KT) but remains understudied in septuagenarian recipients. The study purpose was to analyze the safety and efficacy of single-dose alemtuzumab induction in septuagenarian deceased donor (DD) KT recipients. METHODS: Single center retrospective nonrandomized cohort review of septuagenarian DDKT recipients stratified by induction immunosuppression (single dose alemtuzumab versus multi-dose rabbit anti-thymocyte globulin [ATG]). Standardized management algorithms were used, and all patients received maintenance immunosuppression with tacrolimus/mycophenolate/steroids. RESULTS: From November 2003 to December 2024, 359 DDKTs were performed in septuagenarian recipients with either alemtuzumab (n = 270) or ATG induction (n = 89). Donor and recipient characteristics were largely comparable between the two groups. Five-year patient (70.3% alemtuzumab versus 82.9% ATG, p = 0.054), graft (60.2% alemtuzumab versus 74.7% ATG, p = 0.04) and death-censored graft survival (80.0% alemtuzumab versus 89.1% ATG, p = 0.11) rates favored the ATG cohort. CONCLUSION: ATG induction was associated with improved survival outcomes in our cohort and may be the preferred induction agent in septuagenarians undergoing DDKT versus alemtuzumab. Given the findings of our study, caution is warranted with the use of alemtuzumab in elderly KT patients receiving triple maintenance immunosuppression.