The use of alemtuzumab for induction therapy is increasing. 7.6% of antibody induction recipients in 2003 and 9.3% of induction recipients in 2004 received alemtuzumab. Antibody induction, especially T-cell depleting agents, Thymoglobulin and alemtuzumab are very effective in preventing early acute rejection in the initial hospitalization for both deceased and living donor transplants. However, when examining the effect of antibody induction on acute rejection after the initial hospitalization during the first year, alemtuzumab induction was associated with increased odds of acute rejection in deceased donor transplants compared to no antibody induction, IL-2RA, and Thymoglobulin. There was no difference in acute rejection during the first year after initial hospitalization in living donor transplants among all 4 induction groups. Despite lower acute rejection rates with alemtuzumab induction, no difference in graft survival was observed compared to no antibody induction, IL-2RA, and Thymoglobulin over 24 months. We conclude that alemtuzumab is an effective induction agent in kidney transplantation. However, further studies are needed to assess its long-term efficacy and to establish the optimal immunosuppressive regimen that should be maintained when alemtuzumab is used as an induction agent.