Outcomes Following Alemtuzumab Induction in Deceased Donor Kidney Transplantation According to Recipient Age Categories: A Single Center Report.

INTRODUCTION: The effects of induction therapy with the anti-CD52 monoclonal antibody alemtuzumab on age-specific outcomes following kidney transplantation (KT) remain inadequately studied. This study aimed to analyze the comparative safety and efficacy of single-dose alemtuzumab induction in deceased donor (DD) KT recipients according to different recipient age groups.

METHODS: Single-center retrospective nonrandomized cohort review of DDKT recipients stratified by age (30-49/50-69/ ≥ $ \ge $ 70 years). All patients received a single 30-mg intra-operative dose of alemtuzumab. Standardized management algorithms were used. All patients received triple maintenance immunosuppression with tacrolimus/mycophenolate/steroids.

RESULTS: From September 2012 to December 2018, 723 DDKTs were performed with alemtuzumab induction. Donor age (33.1 ± 15.7 vs. 47.3 ± 16.0 vs. 53.3 ± 13.4 years; p < 0.001) and kidney donor profile index (KDPI, 46.5 ± 25.1 vs. 65.5 ± 23.8 vs. 74.4 ± 20.5%; p < 0.001) increased with increasing recipient age groups. Overall patient (p < 0.001) and graft (p < 0.001) but not death-censored graft survival (p = 0.6) rates decreased with increasing recipient age strata. Rates of delayed graft function, biopsy-proven acute rejection, and infectious complications at 1-year post-transplant were comparable amongst groups.

CONCLUSION: In DDKT recipients, alemtuzumab induction does not appear to confer excess risk of graft failure, acute rejection, or short-term infectious complications in older patients relative to younger counterparts in the setting of triple maintenance immunosuppression.