*Purpose: The aim of our study was to compare the outcomes one-year after renal transplant with a focus on opportunistic infections in patients who received either alemtuzumab or basiliximab for induction immunosuppression therapy.

*Methods: We included all patients who received induction with alemtuzumab for renal transplant between 2011 and 2016 at our center. These were matched 1:2 to basiliximab recipients by age and date of transplant. Electronic medical records were searched for evidence of the following opportunistic infections; BK virus, CMV, VZV, HSV, Cryptococcus, and Histoplasma. Continuous variables were compared using t-tests or Wilcoxon rank-sum tests and categorical variables using Fisher’s tests or chi-square tests. Binary outcomes were compared using Cochran-Mantel-Haenszel tests. Time-to-event outcomes were plotted using the Kaplan-Meier method and compared between groups using log-rank tests.

*Results: Most patients were maintained on tacrolimus, mycophenolate, and prednisone. No statistically significant differences in the following outcomes were detected: delayed graft function (p = 0.76), graft loss (p = 0.99), or rejection (p = 0.2). Opportunistic infection rates were not significantly different at 1-year post-transplant (p = 0.83). Time-to-infection (p = 0.84) and time-to-death (p=0.21) were similar in both groups, but time-to-rejection was longer in the basiliximab group vs alemtuzumab group (p = 0.04).

*Conclusions: Despite a difference in immunological risk between the 2 groups, we did not detect any significant differences in outcomes at 1-year post-transplantation between higher immunological risk patients receiving alemtuzumab and lower risk patients receiving basiliximab. Early opportunistic infectious rates were similar. Surprisingly, no fungal infections were detected at 1-year post-transplant which may represent a delay in detection of any potential risk differences.

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