Induction agents are commonly utilized in the United States to prevent acute rejection in renal transplant recipients. The most common induction agent used is rabbit antithymocyte globulin (ATG). The ideal dosage of this agent has not been established. We performed a prospective randomized study of adult renal transplant recipients to compare our standard dose ATG at 3.75 mg/kg vs study dose of 2.25 mg/kg. Sixty eight patients were assessed for eligibility and forty three where randomized. 57.1% of patients in the standard dose group were caucasian while in the low dose group, 80% were caucasian. This difference was not statistically significant. Delayed graft function was more common in the study group compared with the control group (40% vs 14.3% respectively). However, there were no statistical significant differences in either rejection episodes, graft survival, patient survival, infections or leukopenia.

ATG not only is known to predispose renal transplant recipients to infections and malignancies but it is also a very expensive medication and it is imperative that the safest minimal dose of this agent is found to adequately treat renal transplant recipients. Although this is a small prospective randomized study, this is the first clinical trial documenting the safety and efficacy of lower dose ATG as induction in renal transplantation.

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