Thymoglobulin and Its Use in Renal Transplantation: A Review

Abstract

Thymoglobulin (Thymoglobulin®; Genzyme, Cambridge, Mass., USA) is a polyclonal antibody which has been used in the field of transplantation over the last four decades. With an initial hesitancy, it is widely used now in the prevention and treatment of rejection following renal transplantation. Thymoglobulin's lack of nephrotoxic properties (unlike calcineurin inhibitors) may potentiate it to be a very useful induction therapy during the early days following transplantation, particularly in a donation after circulatory death programme. More recently its role in conjunction with inhibitors of terminal complement activation has been shown to be beneficial in cross-match-positive transplantation. This review article consolidates up-to-date available evidence to address the therapeutic role of thymoglobulin in immunological tolerance, ischemia perfusion, live donor transplantation, delayed graft function, prevention and treatment of rejection, graft survival and post-transplant lymphoproliferative disorder following renal transplantation.

Acute rejection in vascularized composite allotransplantation

“…ATG is prepared by immunizing pathogen-free rabbits with a cell suspension of human thymic tissue (thymocytes), therefore, it yields a polyclonal pool of immunoglobulins against many antigenic targets on T-cells, such as cluster of differentiation (CD)2, CD3, CD4, CD5, CD7 and CD8 [10,11]. ATG causes T-cell depletion by inducing complement-dependent cell lysis.…”

Tailor-Made Induction Therapy in ‘Low Risk’ Renal Transplants; A South Asian Perspective

“…Furthermore, it is recommended to be administered via a central line, to minimize thrombotic complications of the access route [27]. Serious bone marrow suppression with leukopenia and thrombocytopenia has also been reported in up to 30% of recipients [28].…”

Low-Dose RATG with or without Basiliximab in Renal Transplantation: A Matched-Cohort Observational Study

“…Mono- or polyclonal T-cell-depleting antibodies, such as alemtuzumab and RATG, appear to be more effective than monoclonal nondepleting antibodies, such as basiliximab or daclizumab, in preventing the risk of allograft rejection, but are associated with remarkably more severe side effects. RATG may facilitate a protolerogenic state, through depletional and nondepletional mechanisms that include the conversion of CD4+CD25- T-cells into CD4+CD25+ regulatory T-cells [3,4] as well as apoptosis of B-cell lineages, and interference with dendritic and natural killer functional properties [5.] However, they also induce acute infusion-related cytokine-release syndrome and increase the risk of opportunistic infections and lymphoproliferative disorders in the long term [6,7,8].…”