Kidney transplant rejection rate comparing Alemtuzumab versus Basiliximab during covid pandemic against pre-covid period

Abstract Aims To review kidney transplant rejection rate following change in immunosuppression regime due to covid pandemic. Induction immunosuppression changed from Alemtuzumab pre-covid to Basiliximab during covid pandemic period. Maintenance immunosuppressant included the addition of prednisolone to tacrolimus and mycophenolate in the covid period. Methods Retrospective analysis of patients that underwent cadaveric kidney transplant in a single transplant surgical unit. Rejection was confirmed following transplant kidney biopsy. Results Total of 192 patient records were reviewed. 96 patients underwent kidney transplant between March to November 2019 (pre-covid group). 96 patients underwent kidney transplant between March to July 2020 (covid pandemic group). Rejection number pre-covid group was 6 (total number of biopsy was 30). Rejection number covid group was 5 (total number of biopsy was 14). Pre-covid group follow up was for 16 months. Covid group follow up period was for 6 months. Conclusions Early follow up result suggests possibly higher rejection rate with Basiliximab when compared to Alemtuzumab group. Longer term follow up in post-covid kidney transplant needs to be carried out to draw stronger conclusion. Risk of lymphocyte depleting induction agent during covid crisis versus potential higher risk of rejection with non-depleting agent needs to be balanced.