*Purpose: The purpose of this study is to evaluate the safety and efficacy of induction with either anti-thymocyte globulin (ATG) (total dose 5 mg/kg) or alemtuzumab (30 mg) in older kidney transplant recipients.

*Methods: This is a single center, retrospective cohort study at a large academic medical center. Kidney transplant recipients age 65 years and older transplanted between November 1, 2012 and September 1, 2018 who received either ATG or alemtuzumab were included in this study. Patients were excluded if they experienced death prior to discharge, received a prior transplant, or received multi-organ transplantation. Data from both cohorts was compared using Fisher’s exact test and Chi-Square. The primary end-point is biopsy proven acute rejection (BPAR) at 6 months and 12 months post-transplant. Secondary end-points include patient and graft survival, incidence of infection, 30-day readmission rate, and hospital length of stay.

*Results: A total of 115 patients were screened for inclusion and 60 patients were included in this study: 19 received ATG and 41 received alemtuzumab. BPAR at 6 months for ATG and alemtuzumab were 10.5% (2/19) and 2.4% (1/41) respectively, (p=NS). BPAR at 12 months for ATG and alemtuzumab were 10.5% (2/19) and 4.9% (2/41) respectively, (p=NS). The median hospital length of stay for both groups was 4 days and no statistical significance was found for incidence of CMV (cytomegalovirus) infection, BK virus, urinary tract infection, and community acquired pneumonia. Patient and graft survival was greater than 90% in both cohorts (p=NS) and 30-day readmission rates were not statistically significant different between groups.

*Conclusions: The results of this study demonstrate no statistically significant difference in BPAR, incidence of infection, hospital length of stay, patient and graft survival with ATG or alemtuzumab induction in older kidney transplant recipients.

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