Intravenous (IV) rATG for acute rejection (AR) is primarily given on an inpatient basis due to its daily administration, IV access requirement, and monitoring. The purpose of this study is to evaluate a continuous dose (CD) rATG infusion to reduce inpatient length of stay (LOS). Methods: Patients requiring rATG for treatment of biopsy-proven cellular AR were randomized 1:1 to a 24 hour infusion of rATG 6 mg/kg or 4 standard daily doses (DD) of 1.5 mg/kg. Patients with concomitant antibody mediated rejection (AMR) were excluded. Results: To date 12 patients have been randomized, 7 to the CD group and 5 to the DD group. One CD patient who tolerated the infusion well was later diagnosed with AMR on the original biopsy. He required additional AMR therapies (plasma exchange, rituximab, and IVIG) and was therefore excluded from remaining analyses. Baseline characteristics and outcomes are shown below. One CD patient experienced nausea and vomiting requiring anti-emetics and discontinuation of rATG after 75% of the dose. One DD patient experienced chills, chest tightness and indigestion. No other infusion reactions were noted. Vitals were similar between groups except for higher peak systolic blood pressures in the CD group (164 vs. 143 mmHg). Total rATG dose was similar between groups, however CD patients had reduced LOS post-rATG initiation. 3/5 CD and 3/4 DD patients with post-treatment biopsies showed resolution of AR. Infections within 180 days occurred in 2/6 CD (BK and CMV) and 3/5 DD (BK, CMV, and bacteremia) patients.

Conclusion: Preliminary experience suggests that continuous rATG for AR is feasible and reduces LOS.

CITATION INFORMATION: Patel S, Knight R, Kuten S, Nolte J, Gaber A. Continuous Antithymocyte Globulin (rATG) for Treatment of Renal Allograft Rejection: Preliminary Analysis of a Prospective, Randomized Trial. Am J Transplant. 2016;16 (suppl 3).

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