Korean J Transplant 2022;36 Suppl 1:S237

https://doi.org/10.4285/ATW2022.F-3769

pISSN 2671-8790
eISSN 2671-8804

Equine antithymocyte globulin for treatment of acute T-cell

mediated rejection
Navva Pavan Kumar Rao, S. V. Subramanyam

Department of Nephrology, Deccan Hospital, Somajiguda, India

Acute cell mediated rejection is a major worry in the post transplant scenario as it can lead to irreversible nephron loss. Al-
though 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 re-
lated 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 ma-
lignancy 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 treat-
ment regimens as it is an effective and cheap therapy without any adverse events.

Corresponding author: Navva Pavan Kumar Rao

E-mail: pavannavva@yahoo.com

© The Korean Society for Transplantation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/li-
censes/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

www.ekjt.org S237