Pharmacokinetic and pharmacodynamic studies of two different rabbit antithymocyte globulin dosing regimens: Results of a randomized trial

Graft-Versus-Host Disease After Simultaneous Pancreas–Kidney Transplantation: A Case Report and Review of the Literature

“…Our patient responded to this more traditional regimen, as well as targeting higher tacrolimus levels of 12-15 ng/mL. Additionally, with the thinking that the patient's immune system might be able to ''reject'' the donor T cells, the patient underwent plasmapheresis to remove the residual rATG administered during induction immunosuppression (13). Last, although ECP is often used for steroid-refractory GVHD after HSCT, there have been no reports of photopheresis in SOT with acute GVHD.…”

“…Tacrolimus target levels were increased to 12-15 ng/mL (mean measured level 12.9 ng/mL, range 5.8-19.3 ng/mL), MPA was held given leukopenia and rhinovirus infection, and topical steroids were started. She underwent one treatment of plasmapheresis (1.5 plasma volume pheresis using albumin 5% as replacement) to remove circulating rATG that could be contributing to host T cell depletion (13). Over 1 month, she received seven treatments of extracorporeal photopheresis (ECP) with resolution of pruritus after the second treatment.…”

Induction Therapy: Comparison between Poly and Monoclonal Antibodies

“…On the other hand, there is a possible selection bias seen that most of our patients are treated with polyclonal antibodies. However, the time to onset of rejection was shorter in the basiliximub-treated group, explained by the profound initial lymphopenia induced by rATG essentially T helper lymphocytes naive CD4 naive [5,6]. Pulmonary and digestive infections are independently associated with rATG treatment.…”

Preferential depletion of host over donor T cells through in vivo decay of active rabbit-anti-thymocyte globulin levels during reduced intensity conditioning

“…13,14 In our study, we administered the rATG at a lower dose (4.5 mg/kg) on days − 16 and − 15 of the transplant and assessed whether active rATG levels would decline to a subtherapeutic level by the day of infusion of donor cells. Consistent with our hypothesis, active rATG levels were sub-therapeutic (o 1 μg/mL) by day 0 in 82% of assessed patients treated on this study.…”

“…Rabbit ATG (rATG) levels decline fairly rapidly following administration. 13,14 We hypothesized that if a reduced dose of a rATG preparation (Thymoglobulin) were instead administered approximately 2 weeks before the infusion of the graft, in vivo decay of active rATG levels before the infusion of the graft would result in selective depletion of host cellular immunity while sparing donor T cells. We postulated that this regimen would result in high levels of donor T-cell chimerism in the early post-transplant period without resulting in severe post-transplant immunosuppression and associated infections.…”