2026 Eastern States Conference

Title: Optimizing rabbit anti-thymocyte globulin dosing in kidney transplant patients in a tertiary care transplant center
Authors: Kiera Chibuzor, PharmD; QingXiang Mo, PharmD, BCTXP; Angelly Joy Miane, PharmD; Dhara Shah, PharmD, BCPPPS
Learning Objective: Audience will be able to evaluate the financial impact of switching rabbit anti-thymocyte globulin (rATG) dosing from actual body weight to ideal body weight based
Self-Assessment Question: What body weight do you use when dosing rabbit anti-thymocyte globulin?
Background: rATG is vital for kidney transplant induction immunosuppression. Studies challenge lower exposure to rATG due to risk of infection and malignancy. Some centers adapted ideal body weight dosing as rATG has limited distribution into adipose tissue.
Methods: This performance improvement initiative included adult kidney transplant recipients who received rATG for induction therapy from 3/1/2025-8/31/2025 and 10/1/2025-3/31/2026. Patients transplanted in 9/2025 were excluded due to center's transition from actual to ideal body weight-based rATG dosing during this period. Exclusion criteria included retransplant, positive crossmatch, ABO incompatibility, graft loss, or patient death during index admission. Data collected will include number of rATG vials used per patient pre and post-transplant, donor specific antibodies, percentage of patients with delayed graft function, percentage on dialysis after the first month, kidney biopsy frequency, biopsy-proven acute rejection rate, infection rate, patient survival, and graft survival 6 months post-transplant. The study aims to assess whether ideal body weight-based dosing of rATG is effective for induction while limiting overexposure and cost compared to the actual body weight-based strategy.
Results: A total of 66 patients were included in the pre-transition cohort dosed by actual body weight. On average, each patient used 11 vials of rATG. However, if ideal body weight-based dosing had been applied to this cohort, the average vials used would have decreased to 9 vials per patient, corresponding to an estimated cost savings of $132,000.
Conclusion: While the use of ideal body weight dosing for anti-thymocyte globulin does demonstrate significant cost-saving opportunities, the clinical significance are yet to be determined by comparing the pre- and post-transition cohort.