*Purpose: Alemtuzumab (Alem) is a widely used medication for induction therapy in kidney transplantation. However, there is limited evidence comparing outcomes with low versus high dose Alem induction therapy. The aim of this study is to compare differences in post-transplantation outcomes with 30 mg versus reduced dose of Alem.

*Methods: We retrospectively reviewed adult kidney alone transplant recipients at a single center from 1/2017 to 12/2018 according to Alem dose. Patients receiving 15 mg and a weight-based dose (0.3 mg/kg) were analyzed separately and as a combined reduced dose cohort compared with 30 mg.

*Results: Results: There were 79 recipients who received 30 mg, 155 who received 15 mg, and 43 who received a weight-based dose (0.3 mg/kg) of Alem during the study. Age at transplant and CPRA was not different among the groups. Patients receiving 30 mg compared with a reduced dose were more often male (66% vs 51%, p=0.02), had higher weight (93 kg vs 81kg, p<0.01) and BMI (31 kg/m² vs 28 kg/m², p<0.01), and trended towards higher rates of diabetes (44% vs 32%, p=0.053). There were no significant differences in rates of biopsy-proven acute rejection, rehospitalization, major infection (hospitalization required), leukopenia, neutropenia, and CMV or BK viremia according to dose of Alem (Table 1). Acute rejection, infection, leukopenia, and viremia rates remained comparable between groups after controlling for recipient race, weight, CPRA, and other factors.

*Conclusions: Reduced dose Alem was associated with similar efficacy and safety compared with conventional 30 mg dosing. We found no differences in acute rejection or rates of infection and viremia according to dose. Given that patients who received the 30 mg dose had higher weight and BMI, further analysis of weight-based/adjusted dosing strategies are warranted.

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