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RCTs from over two decades ago showed better graft outcomes after treatment of acute TCMR with rabbit anti-thymocyte globulin (rATG) compared to steroids alone and guidelines suggest use of rATG in steroid resistant and vascular rejections (BANFF 2021). However, outcomes and risks-benefits are unclear in the current era of potent induction and maintenance immunosuppression.
This retrospective study was conducted at the Manchester Institute of Nephrology & Transplantation, UK. Standard immunosuppression was with Basiliximab, and Tacrolimus & Mycophenolate Mofetil based immunosuppression.
Pharmacy and histopathology databases were used to identify patients who received rATG following diagnosis of TCMR following transplants performed during 2014-2022. Patients with pre-formed DSAs, ABOi transplant, dual and multi-organ transplants were excluded. 1 patient who declined rATG treatment after 3 days was also excluded.
· 27 patients were included. All patients received 3 doses of pulse methylprednisolone.
· rATG was started at 1.5mg/kg and continued for 7-14 days with dose titration based on peripheral blood & CD3 counts.
· Descriptive stats along with Kaplan Meyer survival analysis was performed.
· Data was censored for last follow-up on 30st September 2023 or death.
Allograft survival following use of rATG in the treatment of acute TCMR was only modest, with a marked decline in efficacy observed in cases of late rejections. To comprehensively assess the risks and benefits of rATG in the context of contemporary immunosuppression protocols, prospective and larger-scale studies are imperative.