Purpose: To compare outcomes of alemtuzumab (alem) and rabbit antithymocyte globulin (rATG) as induction agents in pediatric kidney transplantation.

Methods: A retrospective single-center chart review was performed, assessing patient and graft survival, and rates of biopsy proven rejection (BPAR) in pediatric kidney recipients who received induction therapy consisting of either rATG or alem. Alem was given as a single 10-30mg dose during transplant. rATG (1.5 mg/kg) was started during transplant, then given for a total of 3-5 doses on alternate days post-transplant. Demographic characteristics were compared between the alem and rATG groups using Chi-square test. Patient survival, graft survival, and BPAR rates were also compared between the two groups with 3 years of follow-up.

Results: Between February 1, 2003 and October 30, 2012, 72 pediatric patients, ages 2-21, underwent kidney transplantation and received alem (n=45) or rATG (n=27) for induction. The alem group was younger in age at time of transplant and received a greater number of deceased donor allografts.

Patient survival at 3 years post-transplant was 100% and 96% in the alem and rATG groups respectively. Graft survival was 93% in both the alem and rATG groups at 1 year. Graft survival was 88.9% in the alem group and 81.4% in the rATG group at 3 years. BPAR occurred in 6.6% of alem group and in 18.5% of rATG group at 1 year (p=0.0478) and in 15.6% of alem group and 26% of rATG group at 3 years (p=0.1102).

Conclusion: Multiple dose rATG and single dose alem induction immunotherapy are associated with similar patient and graft survival in children after renal transplantation over a 3 year follow-up period. Alem, compared to rATG may lower kidney allograft BPAR rates during the first year post-transplant, but BPAR rates are similar between the two induction agents in the longer-term.

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