Alemtuzumab induction and belatacept maintenance in marginal pathology renal allografts

Clin Transplant. 2019 Jun;33(6):e13531. doi: 10.1111/ctr.13531. Epub 2019 Apr 11.


We performed a prospective, 12-month, single-center, nonrandomized, open-label pilot study to investigate the use of belatacept therapy combined with alemtuzumab induction in renal allografts with preexisting pathology, as these kidneys may be more susceptible to additional toxicity when exposed to calcineurin inhibitors posttransplant. Nineteen belatacept recipients were matched retrospectively to a cohort of tacrolimus recipients on the basis of preimplantation pathology. The estimated glomerular filtration rate was not significantly different between belatacept and tacrolimus recipients at either 3 or 12 months posttransplant (59 vs 45, P = 0.1 and 56 vs 48 mL/min/1.72/m2 , P = 0.3). Biopsy-proven acute rejection rates at 12 months were 26% in belatacept recipients and 16% in tacrolimus recipients (P = 0.7). Graft survival at 1 year was 89% in both groups. Alemtuzumab induction combined with either calcineurin inhibitor or costimulatory blockade therapies resulted in similar acceptable one-year outcomes in kidneys with preexisting pathologic changes. Longer-term follow-up may be necessary to identify preferential strategies to improve outcomes of kidneys at a higher risk for poor function (

Keywords: Immunosuppressant; donors and donation: extended criteria; fusion proteins and monoclonal antibodies: alemtuzumab; fusion proteins and monoclonal antibodies: belatacept; kidney (allograft) function/dysfunction.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abatacept / pharmacology*
  • Alemtuzumab / pharmacology*
  • Antineoplastic Agents, Immunological / pharmacology
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Rejection / drug therapy*
  • Graft Rejection / etiology
  • Graft Rejection / pathology
  • Graft Survival / drug effects*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Induction Chemotherapy / methods*
  • Kidney Failure, Chronic / surgery
  • Kidney Function Tests
  • Kidney Transplantation / adverse effects*
  • Maintenance Chemotherapy / methods*
  • Male
  • Middle Aged
  • Pilot Projects
  • Postoperative Complications / drug therapy
  • Postoperative Complications / etiology
  • Postoperative Complications / pathology
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Transplantation, Homologous


  • Antineoplastic Agents, Immunological
  • Immunosuppressive Agents
  • Alemtuzumab
  • Abatacept

Associated data