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Abstract: TH-PO836

Anti-Thymocyte Globulin vs. Alemtuzumab Induction and Associated Complications in Kidney Transplantation: A 20-Year Multi-Center Experience

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Sardar, Sundus, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Akkari, Abdel-Rauof M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Gul Yousaf Khan, Mohammad, Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Miller, Ronald P., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Ghahramani, Nasrollah, Penn State College of Medicine, Hershey, Pennsylvania, United States

Antibody-depleting immunosuppression such as anti-thymocyte globulin (ATG) and alemtuzumab are commonly-used induction therapies after kidney transplantation, and may result in varying rates of associated complications including, but not limited to, acute or delayed allograft rejection, leukopenia, sepsis, allograft failure, CMV infection, BK virus nephropathy, or death.


We performed a retrospective multi-center cohort study using TriNetX, a global federated health research network, providing access to electronic medical records across large healthcare organizations [HCOs] grouped into Global Collaborative Network including 97 HCOs.
We identified 4,920 propensity-matched kidney transplant recipients inducted with ATG (n=2460) or alemtuzumab (n=2460) between Jan 2003-2023 from 26 HCOs in 13 countries, compared for clinical outcomes with risk analysis and Kaplan-Meier survival analysis.


Kidney allograft rejection occurred in 1,159(47.1%) patients with alemtuzumab induction as compared to 794(32.3%) patients in ATG cohort(RR=1.460;95%CI 1.36-1.57). Severe sepsis confirmed in 160(6.5%) patients with alemtuzumab vs 179(7.27%) in ATG group(RR=0.894;95%CI 0.73-1.09). With alemtuzumab, 908(36.9%) patients developed leukopenia vs 741(30.1%) patients in ATG cohort(RR=1.225;95%CI 1.13-1.33), and 135(5.48%) died in alemtuzumab group vs 176(7.15%) in ATG group(RR=0.77;95% CI 0.617-0.953). Kidney transplant failure (KTF) was confirmed in 1090(44.3%) patients in alemtuzumab group and 724(29.4%) patients in the ATG group (RR=1.506, 95% CI 1.396-1.624), with graft survival of 53.06% and 67.80% in alemtuzumab vs ATG cohorts, respectively(HR=1.68;95%CI 1.53-1.85; p=0.004). CMV disease confirmed in 860(34.9%) with alemtuzumab induction vs 693(28.8%) in ATG group(RR=1.241;95%CI 1.14-1.35). With alemtuzumab induction, BK virus nephropathy was diagnosed in 370(15.0%) vs 265(10.7%) in ATG group(RR=1.396;95%CI 1.21-1.74).


Kidney transplant patients with alemtuzumab induction had significantly increased risk of rejection, leukopenia, transplant failure, CMV infection, and BK virus nephropathy. Risk of death is significantly less in the alemtuzumab group as compared to ATG group. No significant difference in severe sepsis between alemtuzumab and ATG cohorts.