Korean J Transplant.  2022 Nov;36(Supple 1):S237. 10.4285/ATW2022.F-3769.

Equine antithymocyte globulin for treatment of acute T-cell mediated rejection

• Kumar Rao NP
• Subramanyam SV

• KMID: 2535454
• DOI: http://doi.org/10.4285/ATW2022.F-3769

Abstract

Acute cell mediated rejection is a major worry in the post transplant scenario as it can lead to irreversible nephron loss. Although steroid pulses and ATG (antithymocyte globulin) has been effective, the cost of transplant therapy escalates and the risk of posttransplant infection also increases. We have treated 27 of our post-kidney transplant recipients with biopsy proven pure acute cell mediated rejection over a period of 7 years with equine ATG (eATG) successful. A total of five to 10 doses of eATG were used depending on the severity, each dose given was 10 mg/kg body weight. Of the 27 patients, 26 could complete the treatment and for one patient treatment was stopped because of infection and sepsis. The recipients either had a live related transplant where only pulse steroid was given as induction, or spousal and cadaver transplant where eATG was given as induction therapy. Out of 26 patients who received treatment 21 attained a normal renal function after the therapy and five recipients had partial response. The patients showed excellent response to treatment with no additional risk of infection or malignancy during the follow period. There were no drug related side effects or reactions in the treated patients. The cost of five doses of eATG is USD 1,125 compared to USD 2,500 of rabbit ATG which is significantly less and helps lessen the cost of the therapy. We found that five doses of eATG was sufficient in most of the cases for sustained and effective response. Thus, eATG should be considered as a first line choice of therapy for anti-rejection and perhaps induction therapy in posttransplant treatment regimens as it is an effective and cheap therapy without any adverse events.