Background: Rabbit anti-thymocyte globulin (rATG) has become the most widely used induction agent in kidney transplantation (KTx) and has recently received FDA approval for this indication. While commonly used among practitioners, a variety of dosing strategies have been reported in the literature. An online survey was conducted to characterize rATG usage among transplant centers in the United States.

Methods: An online survey was disseminated to transplant practitioners in the U.S. identified via the American Society of Transplantation (AST) Transplant Pharmacy Community of Practice (TxPharm COP). The survey queried respondents on numerous aspects of rATG dosing, including cumulative rATG dose, dosing weight, route of administration, and monitoring parameters. This survey was approved by the AST TxPharm COP Executive Committee and our local institutional review board.

Results: Twenty-nine responses to the survey were recorded representing 27 transplant centers; one center reported not using rATG as induction therapy and was thus excluded. Respondents (n=26) were primarily pharmacists (96%) with 92% reporting that more than half of their time is dedicated to the care of transplant patients. Twenty centers (77%) reported a target cumulative dose in the range of 4.5-6 mg/kg. Three centers determine cumulative dose according to patient-specific immunologic risk. Two centers routinely utilize CD3 cell counts to determine need for rATG administration. Total body weight was the most commonly reported dosing weight (65%) with 46% of respondents reporting a maximum of 150 or 200 mg per dose. Administration via central or peripheral line was reported as acceptable in 96% of centers; one center reported not utilizing peripheral administration. The majority of respondents (65%) adhere to package insert recommendations for dose reduction or omission.

Conclusions: The use of rATG as induction therapy remains one of the most common practices in KTx. While certain practices are prevalent according to the current survey, considerable variation remains in terms of specific target cumulative dosing, preferred dosing weight, and implementation of maximum doses.

CITATION INFORMATION: Foster K., Dodson A., Gutierrez K. Survey of Rabbit Anti-Thymocyte Globulin Usage for Kidney Transplant Induction Therapy in the United States Am J Transplant. 2017;17 (suppl 3).

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