ABO incompatible [ABOi] live-donor renal transplantation is a successful and accepted form of treatment for patients with end stage renal failure. Most antibody removal protocols are complex and expensive, usually with Rituximab [RTX] induction.

In this study we compare the use of RTX with Alemtuzumab [ALZ] as induction agents with a steroid sparing regime. 63 [39m, 24f; mean age 47 ±11 years] ABOi patients received our steroid sparing regime – prednisolone 1mg/kg for 4 days, 0.5mg/kg for 3 days, then stopped.

24 patients received induction with RTX [1g x 2] and Daclizumab with tacrolimus [tac] and MMF. 39 patients received ALZ induction [50 mgs] and tac monotherapy. Blood group antibody was removed by plasma exchange. Rejection was biopsy proven. Antibody mediated rejection was treated with plasma exchange, ivIg, MMF and steroids and T cell rejection with steroids and MMF.

There was no difference in patient survival at 1 and 3 years post transplantation between the 2 groups, which was 100% and 95.8% in the RTX compared with 97.4% and 97.4% in the ALZ group [p=0.74]. Similarly, 1 and 3 year censored allograft survival did not differ between the 2 groups [90.9% and 86.4% in the RTX vs. 94.4% and 90.5% in the ALZ group; p=0.32].

25/63 [40%] patients experienced rejection. Rejection free survival was similar in both groups; [RTX 70.8% and 58.3% compared to 71.8% and 59.9% in the ALZ group and at 1 and 3 yrs respectively [p=0.78]. The incidence of AMR and TCR was similar in both groups.

Allograft function [MDRD egfr] was similar in both groups; [RTX 50.7 and 53.6 mls/min vs. ALZ 51.8, 47.3mls/min at 1 and 3 years respectively [p>0.05].

Infection free survival was similar the 2 groups; [RTX 61.1% vs. 50.0% compared to ALZ 56.4% and 51.0% at 1 and 3years respectively [p=0.71].

This study shows that induction with either RTX or ALZ produces similar results in ABOi transplantation using a steroid sparing regime.

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