T o be efficacious, immunosuppression regimens require long-term treatment, usually for the life of the patient. Unfortunately, the associated side effects, such as infection, cancer, renal damage, hypertension, diabetes, hyperlipidemia, hirsutism, cushingoid facial appearance, and bone necrosis, may be severe or life-threatening and have a direct impact on patient compliance, thus increasing the potential for rejection. In many cases, the resulting rejection is so far advanced that successful treatment for graft survival is unlikely. Consequently, a major goal of organ transplantation is to prevent rejection, induce graft tolerance, and minimize the use of longterm and high-dose immunosuppression. A pilot study was initiated in 1997 to study the efficacy of alemtuzumab (CAMPATH 1H; ILEXTM Oncology, Inc [ILEX], San Antonio, TX) as an induction therapy in 31 cadaveric renal transplant recipients. Patients received a single dose of alemtuzumab 20 mg intravenously on the day of and the day after transplantation followed by half doses of cyclosporine starting on the third postoperative day (Fig 1). Initial published results of the nonrandomized, open-label, single-center study indicated that alemtuzumab provided acceptable outcomes with high graft survival, low rejection rates, and low infection rates.1,2 Currently, the 5-year follow-up data show strikingly similar trends with a 71% graft survival rate, 84% patient survival rate, low infection rates with no late or unusual opportunistic infections observed, and no reports of malignancies (Figs 2 and 3). Importantly, patient compliance has been excellent