Alemtuzumab on par with basiliximab in elderly kidney transplant recipients

Induction therapy with alemtuzumab shows outcomes comparable to basiliximab in elderly kidney transplant (KT) recipients, a study has shown.

“The optimal choice of induction immunosuppression for elderly KT recipients remains unclear,” the investigators said. “Although alemtuzumab has been associated with escalating risk of death and graft loss in this population, this risk has not been adequately explored.”

This retrospective matched cohort of KT recipients aged ≥65 years compared the safety and efficacy of alemtuzumab with basiliximab induction in this population. Patients who received alemtuzumab induction were matched 1:2 to a basiliximab control.

Allograft survival was the primary outcome. In addition, the investigators measured the incidence of acute rejection, infection, and all-cause mortality.

Fifty-one KT recipients were included in the alemtuzumab group and 102 in the basiliximab group. Baseline demographics were comparable between the two arms, except for more living donor transplant recipients in the alemtuzumab group (51 percent vs 30.4 percent; p=0.02).

Patients on basiliximab more frequently experienced acute cellular rejection within the first year (p=0.02). No difference was seen in the rates of infection within the first year.

During the follow-up period, rates of graft and patient survival were similar between groups. However, patients receiving basiliximab had a higher glomerular filtration rate at 2 years after transplant (59 vs 49 mL/min/1.73 m²; p=0.03).