Evaluation of the Safety and Benefits of Peripherally Administered Anti-Thymocyte Globulin (p-ratg) in Kidney Transplant (kt) Recipients

Document Type

Conference Proceeding

Publication Date

6-1-2023

Publication Title

Am J Transplant

Abstract

Purpose: Due to risk of infusion-associated reactions, the recommended route of administration of rabbit anti-thymocyte globulin is through a high flow vein. Historically, central line access is preferred, but data suggests peripheral administration is a safe alternative. This study aims to better understand the safety, tolerability, and implications of p-rATG administration after institutional practice change from central line administration (Table 1). Methods: This single-center, retrospective analysis evaluated use of p-rATG in KT recipients between August 1st, 2021 and September 30th, 2022. Adult patients who received p-rATG induction were included. The primary outcome was occurrence of local and systemic adverse reactions (ADE). Secondary outcomes evaluated benefits of p-rATG use, like decrease in use of central line placement, time in operative room (OR), and effect on length of stay. Results: There were 41 patients included, with baseline characteristics shown in Table 2. No anaphylaxis, flash pulmonary edema, extravasation, or thrombosis observed. Fourteen patients (34%) experienced minor ADEs, with the majority experiencing hypertension (71%). Of the patients who experienced minor ADEs, 71% received all pre-medications, but only 21% received them within one hour of the start of infusion. Decrease in average bicarbonate levels after first dose from 23.4mmol/L to 19.2mmol/L occurred. No patients required central line placement. Average time in the OR was 3:13 hours (hr) (2:59hr in deceased donor recipients (DDR) and 4:56hr in living donor recipients (LDR)). Median length of stay 5.9 days for DDR and 4.2 days for LDR compared to 5.2 days for DDR and 4.4 days for LDR based on historical institutional data. Conclusions: p-rATG is overall safe and well tolerated, without incidence of major adverse events. Expected infusion reactions occurred mainly due to deviations from protocol, however increased sustained acidosis observed, likely due to volume of infusion. Administration of p-rATG allowed for reduced use of central lines and did not negatively impact stay length. P-rATG administration is a safe strategy for induction administration in KT CITATION INFORMATION: Baik I., Fitzmaurice M., Hanke P., Jantz A., Spaillari F., Summers B., Kim D., Poparad-Stezar A. Evaluation of the Safety and Benefits of Peripherally Administered Anti-Thymocyte Globulin (p-ratg) in Kidney Transplant (kt) Recipients AJT, Volume 23, Issue 6, Supplement 1. DISCLOSURES: I.Baik: None. M.Fitzmaurice: n/a. P.Hanke: n/a. A.Jantz: n/a. F.Spaillari: n/a. B.Summers: n/a. D.Kim: n/a. A.Poparad-stezar: None. [Figure presented]

Volume

23

Issue

6

First Page

S834

Find It @ Sladen

Share

COinS