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A recent study demonstrates comparable rates of acute rejection between induction strategies, effectively neutralising rejection as the differentiating endpoint in contemporary practice. In contrast, clinically meaningful divergence emerges in longer-term outcomes. Alemtuzumab induction is associated with inferior graft function, higher rates of cytomegalovirus and BK viremia, increased post-transplant malignancy, and greater death-censored graft loss. These findings highlight a central paradox in transplant immunology: Strategies that achieve potent early immune suppression may incur delayed biological costs related to immune reconstitution, impaired immune surveillance, and cumulative graft injury. Collectively, the data argue for a shift away from rejection-centred metrics toward a more proportional and individualised approach to induction selection, in which long-term graft preservation and complication risk are weighed as carefully as early rejection prevention.<\/jats:p>","DOI":"10.5500\/wjt.118000","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T15:38:43Z","timestamp":1780414723000},"source":"Crossref","is-referenced-by-count":0,"title":["Alemtuzumab or basiliximab: Rethinking induction choice beyond acute rejection in kidney transplantation"],"prefix":"10.5500","volume":"16","author":[{"given":"Pranjal","family":"Kashiv","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khushboo","family":"Saxena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish 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