Anti-thymocyte globulin administration in donors before intestinal procurement may result in decreased graft versus-host disease (GVHD) due to reduced recipient lymphocyte trafficking after reperfusion. Reluctance in its use by some centers is due to concerns over its effect on hemodynamic status of the donors and on graft survival. This study aims to assess the effect of thymoglobulin infusion in cadaveric multi-visceral (liver/SB/pancreas) & isolated small bowel donors and on allograft outcomes in terms of graft rejection, survival, GVHD and patient survival. A retrospective analysis of all multi-visceral and isolated small bowel donors from 2010 to December 31, 2013 was performed. Data included demographic details of the donor, hemodynamic tolerance after thymoglobulin administration, rejection rate, GVHD incidence, graft and patient survival of all the organs harvested. Data from 40 multi-visceral and 22 isolated SB donors was analyzed. All donors received one dose of thymoglobulin of 3 mg/kg iv in 45min (or less) after lymph node extraction. None of the procurements was aborted due to hemodynamic instability in the donor. Data for 93 harvested organs was available, including 40 multi-visceral grafts, 22 small bowel grafts, 8 hearts, 2 lungs, and 7 livers. At 1 year 23% (n= 5) of the small bowel grafts and none of the multi-visceral grafts were explanted. The patient survival rate after 1 year in multi-visceral transplant recipients was 90% (n=36) and in isolated SB transplant recipients was 91% (n=20). By one year, acute rejection occurred in 45.5% (n=10) of the small bowel grafts and 30% (n=12) of the multi-visceral grafts. The incidence of GVHD was 7.5% in multi-visceral and no patients with small bowel transplant showed evidence of GVHD within one year. The 1 year patient survival was 100%, 63%, and 100% for livers, hearts and lungs, respectively. To conclude, Thymoglobulin can safely be administered during the multi-visceral and small bowel procurements with no significant adverse effects on donor. It has theoretical advantage in graft and patient survival, rejection rate and GVHD incidence without compromising one year survival of the non-intestinal-procured organs.

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