*Purpose: Optimal dosing schemes for rATG induction are not well defined for older kidney transplant recipients (KTRs), who are at greater risk for adverse events from over-immunosuppression. The goals of this study are to assess potential cost-savings with ideal body weight (IBW) vs actual body weight (ABW) rATG induction dosing schemes while maintaining efficacy in older KTRs.

*Methods: This retrospective single-center cohort study included 1^st and 2^nd KTRs age > 60 years transplanted 4/2016-12/2019. Multi-organ KTRs and KTRs with HIV, HCV, or < 30 days follow-up were excluded. Standard immunosuppression included rATG, tacrolimus, mycophenolate, and prednisone taper. KTRs were grouped by total rATG given for induction: the ABW group received > 110% of an IBW-based dose, and the IBW group received < 110% of an IBW-based dose. Costs were calculated by the average wholesale price (AWP) of rATG. The ABW group served as a control for safety and efficacy outcomes within 1-yr post-op. Patients were censored upon graft failure, death, or any safety outcome.

*Results: An interim analysis was performed on 52 KTRs (IBW group n=15; ABW group n=37). KTRs in both groups were similar at baseline (Table 1). IBW-based dosing of rATG resulted in a median cost savings of $4,240/patient (IQR $3,150-$6,300) and a total savings potential of $171,166 within the ABW group. Safety and efficacy data were similar between groups (Table 2).

*Conclusions: An interim analysis showed an opportunity for cost savings with IBW-based rATG induction dosing. There were no differences in safety or efficacy between groups. Data collection/analysis are ongoing.

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