This analysis reports on the outcomes of two different steroid sparing immunosuppression protocols used in the management of 120 highly sensitised patients (HSPs) with cRF>85% receiving Alemtuzumab induction, 53 maintained on tacrolimus (FK) monotherapy and 67 tacrolimus plus mycophenolate mofetil (FK+MMF). There was no difference in the median cRF or mode of
sensitisation between the 2 groups, although the FK+MMF cohort received more poorly matched grafts. There was no difference in one-year patient or allograft survival, however rejection free survival was inferior with FK monotherapy compared with FK+MMF at 65.4% and 91.4% respectively, p<0.01. DSA-free survival was comparable. Whilst there was no difference in rates of BK between the cohorts, CMV-free survival was inferior in the FK+MMF group at 86.0% compared with 98.1% in the FK group, p=0.026. One-year post-transplant diabetes free survival was 89.6% and 100.0% in the FK and FK+MMF group respectively, p=0.027, the
difference attributed to the use of prednisolone to treat rejection in the FK cohort, p=0.006. We report good outcomes in HSPs utilising a steroid sparing protocol with Alemtuzumab induction and FK+MMF maintenance and provide granular data on immunological and infectious complications to inform steroid avoidance in these patient groups.