Medication costs represent one of the largest costs associated with transplantation. With growing pressure to reduce health care costs while maintaining excellent outcomes, this study aimed to demonstrate financial impact of reduced anti-thymocyte globulin (ATG) use using a risk-stratified protocol and adjusted body weight dosing.

This is a retrospective single center study of adult solitary renal transplant patients from 2011 to 2014 comparing the risk stratified (RS) immunosuppression protocol to historic controls (HC). ATG dose for RS was based on immunologic risk (sensitization and age) with 1.5-6 mg/kg dosed based on adjusted body weight. HC patients received either 4.5 or 6 mg/kg dosed with actual body weight. Both populations received tacrolimus with equivalent trough goals, mycophenolate mofetil 1500-2000 mg/day and prednisone. Three year patient and graft survival and rejection. Cost analysis was performed based on actual dose of RS cohort and estimated dose of RS cohort using HC protocol. Univariate and Kaplan-Meier analysis was performed and p<0.05 was consider significant.

169 patients underwent renal transplant, 55 in the HC and 114 in the RS group. Within the RS group, 42 were low risk and 18 were elderly. There was no difference in 3 year patient (RS: 97% vs HC:93%,p=NS) and graft survival (92 vs 91%, p=NS). No significant differences were observed in mean eGFR at 6 months (57 ±20 vs 61 ±17 ml/min/m², p=NS). No differences in ACR were observed at 6 (12 vs 6%, p=NS), 12 (14 vs 13, p=NS) or 36 months (15 vs 16%, p=NS). No differences in AMR were observed at 6 (5 vs 6%, p=NS), 12 (8 vs 6%, p=NS) months. RS received lower ATG dosing per kg (4.3±1.3 vs 4.9 ± 1.6 mg/kg, p=0.01) and total dosage (333 ± 114 mg vs 455 ± 132 mg, p<0.005). The mean cost of ATG was lower in the RS group ($12056 ± 4128 vs $16454 ± 4764, p<0.005). Based on HC protocol, RS would have received a mean of 179 ± 15 mg more ATG with a mean increase in cost of $6489 ± 5418 (p<0.005). The low risk group would have received a mean of 306 mg more ATG with a mean increase in cost of $9287 ± 5851(p<0.005) per patient. The elderly group would have received 330 ± 107 mg more ATG with an increase in cost of $10381 ± 6004 per patient.

The RS protocol implementation significantly reduced total ATG milligram doses in patients of all immunologic risk without impacting excellent graft outcomes. The difference in dosing resulted in improved quality delivered to the transplant patients.

CITATION INFORMATION: Dann J., Ally W., Bradley M., Geyston J., Agarwal A. Improved Value with Individualized Antithymocyte Globulin Dosing Protocol in Renal Transplant Am J Transplant. 2017;17 (suppl 3).

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