Background: Alemtuzumab (AZ) is a humanized anti-CD52 monoclonal antibody used as an induction agent in organ transplantation. The potency of alemtuzumab, is a concern for induction therapy in hepatitis C-seropositive [HCV+]. Methods: US registry data from 2003 to 2010 of adult HCV+ deceased-donor KTX recipients (n=4911) we examined overall patient and death-censored graft survival and 1-year acute rejection by induction agent — alemtuzumab (n=294), other T-cell depleting agents combined (n=1135; T-cell), IL-2 receptor blockade (n=1135; IL-2RAb), and no induction (n=1449). Survival distributions using the Kaplan Meier method and comparison of survival times between induction groups were used the log rank test. Multivariate analysis was conducted using Cox Proportional Hazards or logistic regression with backward selection at an Α level of < 0.2 Results: Each of the induction groups 1year patient survival was 94%, 94%, 92% and 89% and 5year patient survival was 81%, 81%, 75% and 75%, respectively. On multivariate analysis, induction therapy was associated with significantly better overall patient survival with alemtuzumab (adjusted hazard ratio (aHR) 0.63, 95% confidence interval (CI) 0.44, 0.91), other t-cell depleting agents (aHR 0.51, 95%CI 0.40, 0.63) or IL-2RAb (aHR 0.67, 95%CI 0.52, 0.85), compared to no induction. A significant protective effect was also seen with the use of alemtuzumab (aHR 0.63, 95%CI 0.40, 0.99), other t-cell depleting agents (aHR 0.61, 95%CI 0.48, 0.77), and IL2R-Ab (aHR 0.61, 95%CI 0.46, 0.81) in terms of death-censored graft survival relative to no induction. The odds of acute rejection was significantly higher with AZ [adjusted odds ratio (aOR) 1.65, 95%CI 1.09, 2.50), and other T-cell depleting agents (aOR 1.34, 95%CI 1.03, 1.73), but not IL-2RAbs (aOR 1.28, 95%CI 0.95, 1.71). Conclusions: Induction with alemtuzumab and other agents in HCV-positive kidney transplant recipients is associated with better patient and death-censored graft survival compared to non-induction.

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