*Purpose: The ideal total dose of anti-thymocyte globulin (ATG) is unknown in the African American (AA) kidney transplant population.The purpose of this study was to compare AA kidney transplant recipients (KTX) that received <4 gm/kg based on IBW to >4 gm/kg total dose of ATG for induction therapy per the lower range of the package insert dosing recommendation.

*Methods: This was a single center retrospective longitudinal cohort process improvement project of KTX recipients from 7/2017 to 2/2019.Patients were excluded if they were <18 yo,transferred care to an outside facility, received a multiorgan transplant or were taking investigational immunosuppression.At our institution KTX recipients receive 4 doses of 1.5 mg/kg (IBW) of ATG.Outcomes included rejection rates, and a composite endpoint of patient and graft survival. Pearson Chi Square, T-tests and Kaplan Meier analysis were used to compare groups.

*Results: A total of 160 AA patients were included in the analysis.One hundred and sixteen KTX recipients received >4 gm/kg of ATG compared to 44 KTX recipients.Baseline characteristics are shown in table 1.The only significant difference in baseline characteristics was there were more female recipients in the group that received <4gm/kg of ATG(p <0.001).Rates of rejection and opportunistic infections were similar between both groups. Table 2 shows additional outcomes.There was no difference in immunosuppression regimens, doses and troughs. However, this was a significant difference in drug cost between the groups(p<0.005).Patient and graft survival were similar between both groups (figure 1).

*Conclusions: Based on this data it is safe to use a lower dose of ATG for induction in AA KTX recipients.AA recipients are at a higher risk for rejection due to immunologic factors.This study has shown that there was no difference in rejection, graft and patient survival when using a sub-optimal dose of ATG.

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