From the FDA Drug Label
Administration was planned for Days -5, -4, and -3 pre-implantation, followed by 2 days of rest prior to implantation. The ATG is administered 3 days before the kidney transplant, with the last dose given 2 days before the transplant.
- The exact hours after kidney transplant to administer ATG is not specified in the label, but it can be inferred that ATG administration is completed at least 48 hours before the transplant. 1
From the Research
Anti-thymocyte globulin (ATG) should be administered intraoperatively, immediately after kidney transplantation, as this approach has been shown to be safe and effective in preventing delayed graft function and acute rejection 2. The optimal timing of ATG administration is crucial to minimize the risk of adverse reactions and maximize its immunosuppressive effects.
- The standard regimen involves administering ATG as an induction therapy, followed by subsequent doses over the next 1-5 days depending on the specific protocol.
- The dose of ATG can vary, but a modest dose of 3 mg/kg intraoperatively has been shown to be effective in reducing the incidence of delayed graft function and acute rejection 2.
- ATG should be administered through a central line or high-flow vein with premedication including corticosteroids, acetaminophen, and diphenhydramine to minimize infusion reactions.
- Patients require close monitoring for adverse reactions such as fever, chills, hypotension, and thrombocytopenia during ATG administration.
- The latest study in 2023 suggests that a very low dose of ATG (mean total dose of 2.0 mg/kg) can be safe and effective in non-immunized kidney transplant recipients, with a lower rate of biopsy-proven acute rejection and post-transplant diabetes 3.
- Another study in 2023 found that the optimum timing of ATG in relation to adoptive regulatory T cell therapy is crucial, and ATG levels need to decline to lower levels than previously thought for efficacious Treg transfer, which can be achieved within 2 weeks after ATG administration 4.