At what time post kidney transplant is Anti-Thymocyte Globulin (ATG) induction administered?

From the Guidelines

ATG induction therapy should be administered within 6-12 hours after kidney transplantation, with the first dose often given intraoperatively. The standard regimen usually consists of 1.5 mg/kg/day for 3-5 days, with the exact duration depending on the patient's immunological risk profile and institutional protocols 1. It's crucial to administer premedication (acetaminophen, diphenhydramine, and corticosteroids) 30-60 minutes before each ATG dose to minimize infusion-related reactions. The timing is important because ATG works by depleting T-lymphocytes, which are key mediators of acute rejection, and early administration helps prevent the initial immune response against the transplanted kidney. Some key points to consider when administering ATG induction therapy include:

• Monitoring for potential side effects including cytokine release syndrome, thrombocytopenia, and increased infection risk 1
• Adjusting the dosing based on white blood cell and platelet counts, which should be checked daily during the treatment course
• Considering the patient's immunological risk profile and institutional protocols when determining the exact duration of ATG therapy
• Administering premedication to minimize infusion-related reactions The evidence from recent studies suggests that early administration of ATG induction therapy is crucial in preventing acute rejection and improving patient outcomes 1. However, it's also important to consider the potential risks and side effects associated with ATG therapy and to closely monitor patients during treatment.

From the Research

Administration of ATG Induction

• The administration of ATG induction in kidney transplant patients is a crucial aspect of immunosuppressive therapy.
• According to the study by 2, ATG-Fresenius induction is administered as a single high-dose intra-operatively, which is immediately after the kidney transplant surgery.
• The exact timing of ATG induction administration is not explicitly stated in hours, but it is mentioned to be given intra-operatively, implying that it is administered during the surgery or immediately after the transplant.
• The study by 3 does not provide specific information on the timing of ATG induction administration in hours.
• However, the study by 2 suggests that the intra-operative administration of ATG-Fresenius induction is associated with improved patient and graft survival rates.

Dosage and Administration Schedule

• The dosage and administration schedule of ATG induction vary among different studies.
• The study by 4 compares the effectiveness of different ATG dosing regimens, including 9 mg/kg, 6 mg/kg, and 4.5 mg/kg, but does not provide information on the timing of administration in hours.
• The study by 2 uses a single high-dose of 9 mg/kg ATG-Fresenius induction, administered intra-operatively.
• The study by 5 reviews the literature on the use of anti-thymocyte globulins as an induction therapy in kidney transplantation, but does not provide specific information on the timing of administration in hours.

Clinical Implications

• The administration of ATG induction in kidney transplant patients has significant clinical implications.
• The study by 6 compares the long-term outcome of ATG vs. Basiliximab induction and finds that ATG induction is associated with an improved trend in patient and graft survival, but also with a higher rate of CMV infections and haematological complications.
• The study by 2 finds that the intra-operative administration of ATG-Fresenius induction is associated with improved patient and graft survival rates, and reduced risk of graft failure and transplant rejections.
• Overall, the administration of ATG induction in kidney transplant patients requires careful consideration of the dosage, administration schedule, and potential clinical implications.