Rabbit anti-thymocyte globulin induction in renal transplantation: review of the literature

Abstract

Rabbit anti-thymocyte globulin (rATG) has proven benefit as induction therapy in renal transplant recipients, achieving reduced acute rejection rates and better short-term allograft function, with slightly higher rates of complications such as infections and malignancy. Compared with other agents, the most benefit from rATG induction has been observed in renal transplant recipients at high immunologic risk for rejection. However, in special populations, such as pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients, additional information is needed to delineate the absolute benefit of rATG induction compared with other induction agents. Selection of rATG as the choice of induction therapy in renal transplant recipients should be guided by a cost-effective approach in balancing efficacy, safety, and cost. This review summarizes the published literature on efficacy, safety, and cost of rATG induction in renal transplantation.

The epidemiology of early deep vein thrombosis in kidney transplant recipients

“…For instance, Verhave and colleagues did not find induction therapy to be relevant to DVT, but they failed to compare KTRs who received depleting and non-depleting agents. 1 As depleting agents may be associated with thrombocytopenia 24 that should be protective against DVT, our findings suggest that alternate mechanisms initiated by depleting agents such as pro-inflammatory cytokine release or a greater dependence on central venous catheters for administration of these agents may contribute to the higher risk of DVT observed.…”

A-45-Year-Old Female, ABO Matched Living Related Kidney Transplant Recipient, Treatment Completed Hepatitis C Infection, Who Received Anti-Thymocyte Globulin as Induction Therapy Developed Pancytopenia and Acute Antibody Mediated Rejection Recovered with Plasmapheresis, Intravenous Immunoglobulin and Rituximab: Balancing Efficacy, Safety, and Cost!

“…Hence, daily monitoring of white blood cells, T-cell, and platelet counts is necessary; the dose adjustment mainly based on the level of depletion of each cell line. Previous reports proved that rATG induction in renal transplant recipients with high immunologic risk for rejection had more benefits than risks; however, more data were needed for special population like pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients [6]. This patient was hepatitis C-positive; treated well with undetectable viral load one month prior to transplant.…”

“…Individualized dosing combined with therapeutic drug monitoring is recommended to improve outcomes of transplant cases [5]. A cost-effective approach is suggested in prescribing ATG; it should be balanced with not only efficacy but also safety [6][7][8].…”

Induction therapy in heart transplantation: A systematic review and network meta‐analysis for developing evidence‐based recommendations

“…Agents in the lymphocytedepleting group constitute polyclonal antibody preparations, such as rabbit anti-thymocyte or anti-lymphocyte globulin (rATG), as well as the monoclonal antibody, alemtuzumab, which broadly targets and depletes pre-activated lymphocytes, among other immune cells. 3,4 In the lymphocyte non-depleting group, monoclonal interleukin-2 receptor antagonists (IL-2RA) function to transiently inhibit the activity of activated T-lymphocytes, without permanently eradicating them. 5 Differences in their mechanisms of immunosuppression contribute to variations in the reported efficacy and side effects of these IT agents.…”

“…Currently, two groups of agents are used for IT—lymphocyte‐depleting or lymphocyte non‐depleting—targeting the early inflammatory events culminating in cardiac graft rejection. Agents in the lymphocyte‐depleting group constitute polyclonal antibody preparations, such as rabbit anti‐thymocyte or anti‐lymphocyte globulin (rATG), as well as the monoclonal antibody, alemtuzumab, which broadly targets and depletes pre‐activated lymphocytes, among other immune cells 3,4 . In the lymphocyte non‐depleting group, monoclonal interleukin‐2 receptor antagonists (IL‐2RA) function to transiently inhibit the activity of activated T‐lymphocytes, without permanently eradicating them 5 .…”