*Purpose: Rabbit anti-thymocyte globulin (rATG) cumulative dose needed to effectively and safely prevent acute cellular rejection is unknown. This study compares the efficacy of total dose of rATG , &lt 3.5 mg/kg to &gt 3.5 mg/kg (maximum 4.5 mg/kg) to prevent acute cellular rejection with minimal infectious complications, excellent graft and patient survival at 12 months post-transplant.

*Methods: We retrospectively reviewed the data of patients who underwent the first deceased donor kidney transplant from July 2012 to December 2015 and received rATG and tacrolimus-based maintenance immunosuppression. Patients were analyzed according to the cumulative dose of rATG received, &lt3.5 mg/kg and &gt3.5 mg/kg (maximum 4.5 mg/kg), low and high immunological risk. High immunological risk patient was defined as one with at least one of the following criteria: African American, cPRA > 20%, cold ischemia time > 24 hr, DGF, KDPI > 85% and DCD donor. Data were collected up to 12 months. Statistical significance was based on t-test for continuous variables and chi-square analyses for categorical variables.

*Results: More females than males received &gt 3.5 mg /kg of rATG due to possible higher degree of sensitization and subsequently higher cPRA %. It was expected that more patients with donation after circulatory cardiac arrest received rATG &gt 3.5 mg/kg (Table 1). Serum creatinine levels, CMV infection, acute rejection, graft and patient survival rates were not significant different between the groups at 12 months (Table 2).

*Conclusions: First deceased donor kidney transplant patients who are low or high immunological risk and received rATG &gt or &lt 3.5 mg/kg as an induction therapy and tacrolimus-based immunosuppression have no significant different outcome. Larger studies with longer follow-up are required to confirm these findings.

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