Introduction: The use of alemtuzumab as an induction agent for renal transplantation is increasing in the UK. There is some evidence to suggest that this is safe in the short and medium term, but concern remains over long term safety because of profound and enduring effects on the lymphoid compartment. This report attempts to address some of the safety concerns of alemtuzumab in standard risk renal transplantation.

Methods: Data was extracted from the NHSBT database The analysis included standard risk adults (excluding HLAi, ABOi and highly sensitised patients) undergoing a first kidney-alone transplant in the UK between 2005 and 2013. The outcomes of those patients receiving alemtuzumab (Group A) were compared with those receiving other agents, mainly IL2-Receptor antagonists (Group B). There were 14,027 patients in total, 1,519 in Group A and 12,508 in Group B.

Results: There was no significant difference in graft or patient survival up to five years post transplantation. Group A did have a significantly higher proportion of patients that were rejection free (p=0.012, log-rank test). The median time to rejection was 126 days in Group A, vs. 35 days in Group B. Graft function was not significantly different at any time point to five years. The proportions of patients who were steroid–free were higher at all time points in Group A (1yr 90.8% vs. 20.3%, 3yrs 83.5% vs. 32.6%, 5yrs 85.4% vs. 38.5%). The aetiology of graft loss was similar in both groups.

Discussion: Despite concerns over long term safety regarding the use of alemtuzumab in renal transplant recipients UK registry data is reassuring suggesting similar overall performance to alternative induction agents. However alemtuzumab does permit significantly higher numbers of patients to avoid steroids without any obvious penalty.

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