Thymoglobulin is a commonly used induction agent for kidney transplantation. Optimal dosing for thymoglobulin is not well defined, and weight based dosing is often used. We categorized thymoglobulin exposure into three groups based on three different parameters- parameter 1 (<5 mg/kg vs. ≥ 5 mg/kg), parameter 2 (CD3 count ≤10 vs. > 10 by day 7) and parameter 3 (CD3% ≤1% vs. >1% of pre-transplant CD3 count by day 7). We compared clinical, histological, immunological and infectious disease outcomes within each group, in an attempt to define the best thymoglobulin exposure or dose for optimal clinical outcomes.

Results– Between 4/2014 and 1/2016, 315 adult kidney alone transplants received thymoglobulin at our center. Weight based dosing information was available on all patients (n=315) while 255 patients had data on pre- and post-transplant CD3 counts and percentages. Incidence of leucopenia at 3m, BK viruria or viremia at 1m, 3m or 12 m or any positive value within a year and BKVN were not different within the groups (all p> 0.05). On a 3 month protocol biopsy (n=138), incidence of T-cell rejection was higher in patients with CD3 count >10 (p=0.034), but there was no difference within groups based on dose or CD3% (p=0.61 and 0.22). There was no difference in 12-month protocol biopsy (n=120) within the three groups (all p> 0.05). Mean acute inflammatory scores in 3m and 12 m protocol biopsies and clinical acute T cell rejections up to 18 months also did not differ within the three groups (p>0.05).

Conclusion: Our study did not reveal any differences in incidence of leucopenia, BKV infection, sub-clinical, or clinical rejection and degree of inflammatory scores among kidney transplant patients with i) Thymoglobulin dose <5 vs. ≥ 5mg/kg, ii) CD3 ≤10 vs. >10 and iii) CD3 %≤1 vs. >1.

CITATION INFORMATION: Sood P., Christine W., Mehta R., Tevar A., Puttarajappa C., Schonder K., Shimko K., Hariharan S. Thymoglobulin Dose and Effect on Short-Term Kidney Transplant Outcomes Am J Transplant. 2017;17 (suppl 3).

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