Rabbit antithymocyte globulin (rATG or Thymoglobulin) is the most common agent used in more than 55% of transplant cases in the USA, despite not being FDA-approved for this use (only for treatment of severe cellular rejection). Curiously, rATG is prepared by immunizing pathogen-free
rabbits with a cell suspension of human thymic tissue (thymocytes). After immunization, the serum is harvested from rabbits and immunoglobulins against thymocytes are isolated and subjected to a number of purification processes. Samples from more than 26,000 immunized rabbits are pooled to achieve a high level of batch-to-batch consistency!
Our center uses ATG for induction in high immunological risk patients and Basiliximab for low risk patients in combination with tacrolimus and MMF for maintenance. Steroid withdrawal is performed on most patients by the end of first week post-transplantation, with the exception of highly sensitized patients.
Below a summary table of the 3 most common induction agents in clinical use today, their target cells, dose, cost and side effects.
|Antibody||Brand||Class||Lymphocyte depleting||Antigenic Target and Cells||Typical prescription||Side effects|
IL2 receptor (CD25)
Activated T cells
|20mg x2 doses U$4,254||Hypersensitivity reaction (rare)|
|Rabbit antithymocyte globulin||Thymoglobulin (Genzyme)||Polyclonal||Yes||
Mainly T cells, to a lesser extent B and NK
3-7 doses U$7,824-18,256
Premedicate with steroids and Tylenol
Decrease dose if WBC<3 or="" ptls="" span=""> 3>
Fever, chills, dyspnea, nausea, diarrhea,
headache, general pain and pulmonary
edema (cytokine release syndrome)
|Alemtuzumab||Campath 1H (Berlex Laboratories)||Monoclonal||Yes (more prolonged)||
T, B and NK cells, monocytes,
macrophages, dendritic cells, eosinophils,
|30mg x1 dose U$2,065||
Generally none when given
More details about the use of induction therapy in transplantation on this prior blog