Use of an Ideal Body Weight-Based Rabbit Anti-Thymocyte Globulin Dosing Protocol in Kidney Transplant Recipients to Decrease Cost and Maintain Outcomes at a Large Academic Medical Center
1Pharmacy, Mayo Clinic, Rochester, MN, 2Transplantation Surgery, Mayo Clinic, Rochester, MN
Meeting: 2019 American Transplant Congress
Abstract number: D17
Keywords: Dosage, Economics, Induction therapy, Rejection
Session Information
Session Name: Poster Session D: Quality Assurance Process Improvement & Regulatory Issues
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: This quality improvement study sought to assess if rejection post-transplant was increased following implementation of an ideal body weight (IBW)-based dosing protocol for patients receiving rabbit anti-thymocyte globulin (rATG) for induction at the time of kidney transplant compared to an actual body weight (ABW)-based protocol. Contemporary dosing strategies for rATG aim to reduce cumulative exposure, minimizing risk for significant long-term adverse events. A novel strategy using IBW-based dosing of rATG has been trialed, however concern for potential increases in rejection post-transplant exist due to lower cumulative doses of rATG.
*Methods: This was a retrospective before-and-after study surrounding the implementation of an IBW-based dosing protocol for rATG in adult kidney transplant patients. We compared 75 kidney transplant recipients who received induction therapy with rATG dosed based on ABW (pre-protocol group) in 2013 to 64 kidney transplant recipients who received induction therapy with rATG dosed based on IBW (post-protocol group) in 2015. Demographics, type of kidney transplant, doses of rATG, and episodes of acute cellular or antibody-mediated rejection based on institutional criteria for two years post-transplant or at last follow-up were collected via retrospective chart review. Cost of rATG was calculated based on number of 25 mg vials necessary for the dose the patient would have received based on ABW and IBW using drug acquisition cost at time of medication administration.
*Results: The mean cumulative rATG dose in the pre-protocol group was 6.3 mg/kg of ABW. When IBW was used to guide dosing in the post-protocol group, the mean dose was 4.5 mg/kg of ABW. Protocol adherence was 77%. The rate of rejection was 18.7% in the pre-protocol group and 23.4% in the post-protocol group. The difference between these rates was not statistically significant (p=0.491). The actual annual cost savings after protocol implementation exceeded $2,500 per patient.
*Conclusions: Results suggest IBW-based dosing of rATG may reduce cumulative exposure and medication cost, without significantly impacting the risk of rejection in kidney transplant recipients.
To cite this abstract in AMA style:
Myhre LJ, Bubik RJ, Peterson KT, Personett HA, Crow SA, Dean PG. Use of an Ideal Body Weight-Based Rabbit Anti-Thymocyte Globulin Dosing Protocol in Kidney Transplant Recipients to Decrease Cost and Maintain Outcomes at a Large Academic Medical Center [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/use-of-an-ideal-body-weight-based-rabbit-anti-thymocyte-globulin-dosing-protocol-in-kidney-transplant-recipients-to-decrease-cost-and-maintain-outcomes-at-a-large-academic-medical-center/. Accessed May 18, 2025.« Back to 2019 American Transplant Congress