*Purpose: Thymoglobulin (ATG) is used only in few UK centres as induction. We have previously shown good results with ATG for pancreas transplants. The aim of this study is to see if the total ATG dose used for induction in DCD kidneys affected the outcome and if the initial impact to the blood cells and CD3 count was predictive of its efficacy.

*Methods: All 140 DCD patients who received ATG (Sanofi) induction (standard of care for DCD patients at the reporting centre) were included. Intended dose was 1.25 mg/kg for 5 days rounded to the nearest 25 and not exceeding 150 mg/dose. Patients were separated to 4 quartiles according to the total dose/kg they received. Outcomes examined were total dose depended rejection, and eGFR, and if the initial cell response to the ATG was predictive of those outcomes.

*Results: Rejection (including borderline changes) was less than 12% in 3 years and was predictive of eGFR at 12 (p=0.05) and 36 months (p=0.1). The total dose or dose/kg was not predictive of rejection rate but they were both equally predictive of the WCC at day 5 (p=0.04) and lymphocyte count at day 5 (p=0.006, Pearson correlation of dose/kg and day5 lymphocyte -0.36). Platelets dropped but had no correlation with dose/kg. In non-rejectors the lowest dose/kg quartile was associated with 10mls/min lesser eGFR at 12 months compared to the other quartiles (p=0.06).In a subset of patients (30) CD3 count was available at day 3. Day CD3 was associated with rejection (p=0.001) and inversely associated with eGFR at 12 and 36 months (p=0.03).

*Conclusions: There is a variable response to ATG even within a tight dose range. WCC and lymphocyte count at day5 better reflect the dose compared to platelets unlike what previously believed. Less than 4.5 mg/kg of ATG total dose might be associated with worse outcome. Day3 CD3 count is correlated strongly with rejection and eGFR. This is the first study that shows that CD3 count is predictive of eGFR

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