ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -1 مورد

Antithymocyte globulin (rabbit derived, Thymoglobulin): Drug information

Antithymocyte globulin (rabbit derived, Thymoglobulin): Drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Antithymocyte globulin (rabbit derived, Thymoglobulin): Patient drug information" and "Antithymocyte globulin (rabbit derived, Thymoglobulin): Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Experienced physician:

Anti-thymocyte globulin should only be used by physicians experienced in immunosuppressive therapy in transplantation.

Brand Names: US
  • Thymoglobulin
Brand Names: Canada
  • Thymoglobulin
Pharmacologic Category
  • Immune Globulin;
  • Immunosuppressant Agent;
  • Polyclonal Antibody
Dosing: Adult

Note: Premedicate with corticosteroids, acetaminophen, and/or an antihistamine 1 hour prior to infusion to reduce the incidence and severity of infusion-related reactions. Administer antifungal and antibacterial prophylaxis therapy if clinically indicated. Antiviral prophylaxis is recommended in all patients against herpes simplex virus (Ref) and prophylaxis against cytomegalovirus (CMV) in patients who are CMV-seropositive at the time of transplant and for CMV-seronegative patients scheduled to receive an organ from a CMV-seropositive donor.

Graft-versus-host disease, chronic, prevention

Graft-versus-host disease, chronic, prevention (in hematopoietic cell transplantation) (off-label use): IV: 0.5 mg/kg administered 2 days prior to transplant and 2 mg/kg administered 1 day before and 1 day after transplant (Ref) or 2.5 mg/kg once daily for 3 days beginning 3 days prior to transplant (Ref).

Heart transplant, acute cellular rejection, treatment

Heart transplant, acute cellular rejection, treatment (off-label use): IV: 0.75 to 1.5 mg/kg/day for 5 to 14 days (Ref).

Heart transplant, induction therapy

Heart transplant, induction therapy (in high-risk patients) (off-label use): IV: 1 to 1.5 mg/kg once daily for up to 7 days; frequency of dosing may be modified based on CD3 count (eg, repeat dose only administered when CD3 count >25 cells/mm3) (Ref).

Intestinal and multivisceral transplantation, induction therapy

Intestinal and multivisceral transplantation, induction therapy (off-label use): IV: 2 mg/kg/day on postoperative days 0, 2, 4, 6, and 8 (in combination with rituximab ± basiliximab) (Ref).

Intestinal transplant, acute cellular rejection, treatment

Intestinal transplant, acute cellular rejection, treatment (off-label use): Note: Optimal dose, frequency, and duration of therapy have not been established and vary based on institutional protocols. Administer as part of an appropriate combination regimen.

IV: 1.5 mg/kg once daily for 10 to 14 doses (Ref).

Liver transplant, induction therapy

Liver transplant, induction therapy (off-label use): Note: Optimal dose, frequency, and duration of therapy have not been established and vary based on institutional protocols. Administer as part of an appropriate combination regimen.

IV: 1.5 mg/kg every other day for 2 to 3 doses (Ref) or 1.5 mg/kg once daily for 3 doses (Ref).

Liver transplant, severe acute cellular rejection, treatment

Liver transplant, severe acute cellular rejection, treatment (off-label use): Note: Optimal dose, frequency, and duration of therapy have not been established and vary based on institutional protocols. Administer as part of an appropriate combination regimen for steroid resistant rejection.

IV: 1 mg/kg to 1.5 mg/kg once daily for 4 to 7 doses (Ref).

Kidney transplant, induction therapy

Kidney transplant, induction therapy: Note: The manufacturer recommends actual body weight for dosing; however, other strategies have been used. These include ideal body weight (Ref) or cumulative dosing (ie, 5 mg/kg) (Ref); refer to center-specific protocols.

IV: 1.5 mg/kg/day for 4 to 7 days; the first dose should be administered prior to reperfusion of the donor kidney; the dose and duration may vary depending on concurrent maintenance immunosuppression and patient- and/or allograft-specific variables (Ref).

Kidney transplant, rejection

Kidney transplant, rejection: IV: 1.5 mg/kg/day for 7 to 14 days.

Lung transplant, induction therapy

Lung transplant, induction therapy (off-label use): IV: 1.5 mg/kg/day for 3 days; the first dose was administered within 24 hours of transplantation (Ref). Additional trials may be necessary to further define the role of antithymocyte globulin (rabbit) for prevention of rejection after lung transplant.

Lung transplant, persistent acute cellular rejection, treatment

Lung transplant, persistent acute cellular rejection, treatment (off-label use): IV: Pulse treatments have been used to manage persistent acute cellular rejection (Ref). Additional data may be necessary to further define the role of antithymocyte globulin (rabbit) in treatment of acute cellular rejection after lung transplantation.

Pancreas transplant, induction therapy

Pancreas transplant, induction (off-label use): Note: Optimal dose, frequency, and duration of therapy have not been established and vary based on institutional protocols. Administer as part of an appropriate combination regimen.

IV: 1 to 1.5 mg/kg once daily or every other day for 3 to 7 doses (Ref).

Pancreas transplant, severe acute cellular rejection, treatment

Pancreas transplant, severe acute cellular rejection, treatment (off-label use): Note: Optimal dose, frequency, and duration of therapy have not been established and vary based on institutional protocols. Administer as part of an appropriate combination regimen.

IV: 1.5 mg/kg once daily for 5 to 10 doses (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Obesity: Adult

American Society for Blood and Marrow Transplantation (ASBMT) practice guideline committee position statement on chemotherapy dosing in obesity: Utilize actual body weight (full weight) to calculate mg/kg dosing for hematopoietic stem cell transplant conditioning regimens (Ref).

Dosing: Adjustment for Toxicity: Adult

Solid organ transplantation:

WBC count 2,000 to 3,000 cells/mm3 or platelet count 50,000 to 75,000 cells/mm3: Reduce dose by 50%.

WBC count <2,000 cells/mm3 or platelet count <50,000 cells/mm3: Consider discontinuing or holding dose until counts rebound.

CD3+ lymphocyte count: Thresholds for discontinuing, holding, or decreasing dose vary based on center-specific protocols; length of CD3 suppression depends on type of organ transplant, concurrent immunosuppression, and other organ function (eg, kidney function); one example of dose adjustment based on CD3 count is to discontinue or hold the dose at a CD3 count <25 cells/mm3 and redose when CD3 count is >25 cells/mm3; these strategies require daily to every-other-day CD3 count monitoring (Ref).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Antithymocyte globulin (rabbit derived, Thymoglobulin): Pediatric drug information")

Note: Premedicate with corticosteroids, acetaminophen, and/or an antihistamine 1 hour prior to infusion to reduce the incidence and severity of infusion-related reactions. Administer antifungal and antibacterial prophylaxis therapy if clinically indicated. For use in solid organ transplantation (ie, kidney), antiviral prophylaxis is recommended in patients who are CMV-seropositive at the time of transplant and for CMV-seronegative patients scheduled to receive a kidney from a CMV-seropositive donor.

Aplastic anemia, refractory

Aplastic anemia, refractory: Limited data available: Children and Adolescents: IV: 3.5 mg/kg/day once daily for 5 days in combination with cyclosporine (Ref); Note: Consistent with observations in adult patients, rabbit-antithymocyte globulin is less effective than horse-antithymocyte globulin when either combined with cyclosporine in children and adolescents for initial treatment of severe aplastic anemia (Ref)

Hematopoietic stem cell transplant; graft-versus-host disease prevention

Hematopoietic stem cell transplant; graft-versus-host disease (GVHD) prevention: Limited data available; regimens and protocols variable; refer to institutional protocols: Infants, Children, and Adolescents: IV: Usual reported TOTAL dose range: 4.5 to 15 mg/kg total divided into 3 to 5 once daily doses administered pretransplant; usual regimen is 3 to 4 doses on consecutive days in combination with chemotherapy or radiation (Ref). In adolescents ≥16 years, a lower total dose and timing approach has been successfully used: IV: 0.5 mg/kg/day 2 days before transplantation, 2 mg/kg/day 1 day before transplantation, and 2 mg/kg/day 1 day after transplantation (total dose: 4.5 mg/kg; in addition to standard GVHD prophylaxis) (Ref)

Solid organ transplantation

Solid organ transplantation: Note: Doses and timing may vary; refer to institutional specific protocols:

Kidney transplantation: Infant, Children, and Adolescents:

Induction, prophylaxis: IV: 1.5 mg/kg/dose once daily for 4 to 10 doses initiated at time of transplant prior to reperfusion of donor kidney; during variable and dependent on other immunosuppressive regimens (Ref)

Acute rejection, treatment: IV: 1.5 mg/kg/dose once daily for 7 to 14 days

Heart/lung transplantation: Limited data available: Infant, Children, and Adolescents:

Induction, prophylaxis: Reported range: IV: 1 to 2 mg/kg/dose once daily infused over 12 hours for 5 days; dose dependent on baseline platelet count; in trials the following doses were used based on platelet count (Ref):

>150,000/mm3: IV: 2 mg/kg/dose

100,000 to 150,000/mm3: IV: 1.5 mg/kg/dose

50,000 to <100,000/mm3: IV: 1 mg/kg/dose

Acute rejection, treatment: IV: 2 mg/kg/dose once daily for 5 days (Ref)

Liver, intestinal, or multivisceral transplant: Limited data available: Infants, Children, and Adolescents:

Induction, prophylaxis: IV: Total dose of 5 mg/kg divided into separate pre- and post-op doses: 2 to 3 mg/kg over 6 to 8 hours before allograft reperfusion, followed by the remainder 2 to 3 mg/kg over 6 to 8 hours post-operative; used in combination with other immunosuppressives (Ref)

Rejection: 1.5 mg/kg/dose once daily; duration variable (usually at least 4 to 5 days) based upon biopsy results (Ref)

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Cardiovascular: Hypertension (18% to 37%), hypotension (10% to 16%), peripheral edema (20%), tachycardia (7% to 23%)

Dermatologic: Acne vulgaris (12%), diaphoresis (6% to 13%), skin rash (7% to 13%)

Endocrine & metabolic: Hyperkalemia (17% to 57%), hyperlipidemia (15%), hypokalemia (6% to 12%)

Gastrointestinal: Abdominal pain (8% to 38%), constipation (15% to 33%), diarrhea (6% to 20%), nausea (29% to 37%), vomiting (12% to 20%)

Genitourinary: Urinary tract infection (39% to 42%)

Hematologic & oncologic: Anemia (12% to 25%), leukocytosis (13%), leukopenia (21% to 63%), thrombocytopenia (9% to 37%)

Infection: Cytomegalovirus disease (6% to 13%), infection (17% to 76%; severe infection: 23%), sepsis (6% to 12%)

Nervous system: Anxiety (7% to 14%), chills (9% to 57%), headache (18% to 40%), insomnia (12% to 20%), malaise (9% to 13%), pain (26%)

Neuromuscular & skeletal: Arthralgia (15%), asthenia (13%), back pain (12%), myalgia (11% to 20%)

Respiratory: Dyspnea (15% to 28%), lower respiratory tract infection (≤13%), pulmonary disease (12%), upper respiratory tract infection (11%)

Miscellaneous: Fever (13% to 46%)

1% to 10%:

Cardiovascular: Chest pain (9%), edema (6%)

Dermatologic: Pruritus (6%)

Endocrine & metabolic: Acidosis (6% to 9%), hyperphosphatemia (6% to 7%), hypophosphatemia (6%)

Gastrointestinal: Anorexia (6%), dyspepsia (10%), gastritis (1%), intestinal candidiasis (5%), oral candidiasis (6%)

Hematologic & oncologic: Lymphoproliferative disorder (posttransplant: 2%), malignant neoplasm (4%)

Hypersensitivity: Serum sickness (1% to 2%)

Infection: Herpes simplex infection (5%), herpes zoster infection (5%)

Respiratory: Increased cough (7%), nasopharyngitis (5%)

<1%: Hypersensitivity: Anaphylactic shock

Frequency not defined: Miscellaneous: Infusion related reactions

Postmarketing:

Hematologic & oncologic: Disorder of hemostatic components of blood, disseminated intravascular coagulation, febrile neutropenia, malignant lymphoma, malignant solid tumor

Hepatic: Increased serum transaminases

Hypersensitivity: Anaphylaxis, cytokine release syndrome

Miscellaneous: Reactivation of disease

Contraindications

Hypersensitivity (allergy or anaphylaxis) to rabbit proteins or any component of the formulation; active acute or chronic infection which contraindicate additional immunosuppression

Warnings/Precautions

Concerns related to adverse effects:

• Hematologic effects: Reversible leukopenia, neutropenia, thrombocytopenia, and lymphopenia may occur. Monitor blood counts. Leukopenia and/or thrombocytopenia may require dosage adjustment.

• Hypersensitivity: Hypersensitivity and fatal anaphylactic reactions have been reported. Stop infusion immediately if anaphylactic reaction occurs. Immediate treatment (including subcutaneous epinephrine and corticosteroids) should be available during infusion for management of hypersensitivity.

• Infection: Severe infections (bacterial, fungal, viral and/or protozoal) may develop following concomitant use of immunosuppressants with antithymocyte globulin. Reactivation of infections (particularly CMV) and sepsis have been reported. Appropriate antiviral, antibacterial, antiprotozoal, and/or antifungal prophylaxis is recommended. Monitor closely for infection.

• Infusion reactions: Release of cytokines by activated monocytes and lymphocytes may lead to cytokine release syndrome (CRS) during infusion; may cause serious cardiopulmonary events (sometimes fatal). Rapid infusion rates have been associated with CRS (case reports). Other infusion reaction symptoms, including flu-like symptoms (fever, chills, nausea, muscle/joint pain) may also occur. Local infusion site reactions (pain, swelling, skin redness) have been reported.

• Malignancy: Immunosuppressants, including antithymocyte globulins may increase the incidence of malignancies, including lymphoma, post-transplant lymphoproliferative disease (PTLD) or other malignancies; may be fatal.

Concurrent drug therapy issues:

• Immunizations: Patients should not be immunized with attenuated live viral vaccines during or shortly after treatment; safety of immunization following therapy has not been studied.

Disease-related concerns:

• Liver transplantation induction: Antithymocyte globulin (rabbit) has been associated with increased adverse effects when used for induction in liver transplantation and should be used cautiously in this population (Boillot 2009)

Other warnings/precautions:

• Administration: Initial dose must be administered over at least 6 hours into a high flow vein. Reducing the infusion rate (and prolonging the administration time) may minimize infusion reactions. May pretreat with an antipyretic, antihistamine, and/or corticosteroid.

• Experienced physician: [US Boxed Warning]: Should only be used by physicians experienced in immunosuppressive therapy in transplantation. Maintenance immunosuppression may require dosage reduction. Medical surveillance is required during the infusion. Should be administered in combination with other immunosuppressants.

• Product selection: Antithymocyte globulin (ATG) (rabbit) is available (based on region) in different product formulations, ATG-Thymoglobulin and ATG-Fresenius; the dosing differs among the formulations. Dosing of antithymocyte globulin (rabbit) also differs from dosing of other antithymocyte globulin products (eg, ATG [equine]); protein compositions and concentrations are different. Use caution to ensure dose prescribed is intended for product being administered.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous:

Thymoglobulin: 25 mg (1 ea) [contains glycine, mannitol, sodium chloride]

Generic Equivalent Available: US

No

Pricing: US

Solution (reconstituted) (Thymoglobulin Intravenous)

25 mg (per each): $1,343.36

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous:

Thymoglobulin: 25 mg (1 ea)

Administration: Adult

IV: Infuse the first dose over at least 6 hours; subsequent doses may be infused over at least 4 hours. Infuse through a high-flow vein (central line). Administer through an in-line 0.22 micron filter. Premedication with corticosteroids, acetaminophen, and/or an antihistamine 1 hour prior to infusion may reduce the incidence and severity of infusion-related reactions. Reducing the infusion rate may minimize infusion reactions. Infusion rate may vary for off-label uses; refer to specific protocol.

In kidney transplantation, administration through a peripheral vein has been reported with the addition of 1,000 units heparin and 20 mg hydrocortisone (in 500 mL NS only) to decrease the risk of thrombosis and phlebitis (Ref). The first 2 doses were infused over 6 hours and subsequent doses were infused over 4 hours (Ref). Some centers choose not to use additives and administer the dose at a concentration of 1 mg/mL diluted in NS, with the first dose administered over 4 to 6 hours and subsequent doses over 2 to 4 hours (Ref).

Administration: Pediatric

Parenteral: Administer by slow IV infusion over 6 to 12 hours for the preconditioning/induction dose or over 6 hours for the initial acute rejection treatment dose; infuse over 4 hours for subsequent doses if first dose tolerated. Administer through an in-line filter with pore size of 0.22 microns via central line or high flow vein. Premedication with corticosteroids, acetaminophen, and/or an antihistamine may reduce infusion-related reactions.

Use: Labeled Indications

Kidney transplant rejection: Prophylaxis and treatment of acute rejection in kidney transplantation (in conjunction with concomitant immunosuppression).

Note: In a multicenter, double-blind, randomized trial, antithymocyte globulin (rabbit) was shown to be superior to antithymocyte globulin (equine) in reversing acute rejection and preventing subsequent episodes (Gaber 1998). Based on data from studies (including 10 years follow up) comparing ATG (rabbit) to ATG (equine) for induction, ATG (rabbit) has emerged as the T-cell lymphocyte depleting induction therapy of choice over ATG (equine) in adult kidney transplantation due to its improved efficacy and lower incidence of acute rejection (Brennan 1999; Hardinger 2008).

Use: Off-Label: Adult

Chronic graft-versus-host disease, prevention (in hematopoietic cell transplantation); Heart transplant, acute cellular rejection, treatment; Heart transplant, induction therapy; Intestinal and multivisceral transplantation, induction therapy; Intestinal transplant, acute cellular rejection, treatment; Liver transplant, induction therapy; Liver transplant, severe acute cellular rejection, treatment; Lung transplant, induction therapy; Lung transplant, persistent acute cellular rejection, treatment; Pancreas transplant, induction therapy; Pancreas transplant, severe acute cellular rejection, treatment

Medication Safety Issues
Sound-alike/look-alike issues:

Antithymocyte globulin rabbit (Thymoglobulin) may be confused with antithymocyte globulin equine (Atgam)

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (immunosuppressant agent, parenteral and oral) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care and Long-Term Care Settings).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Abrocitinib: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Antithymocyte Globulin (Equine): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of immunosuppressive therapy is reduced. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor

Antithyroid Agents: Myelosuppressive Agents may increase neutropenic effects of Antithyroid Agents. Risk C: Monitor

Baricitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Baricitinib. Risk X: Avoid

BCG Products: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of BCG Products. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Belatacept: Antithymocyte Globulin (Rabbit) may increase adverse/toxic effects of Belatacept. Specifically, the risk for venous thrombosis of the renal allograft may be increased. Management: A 12-hour interval between administration of these 2 agents is suggested if these agents are to be used concomitantly. Monitor for venous thrombosis of the renal allograft. Risk D: Consider Therapy Modification

Brincidofovir: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Brincidofovir. Risk C: Monitor

Brivudine: May increase adverse/toxic effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Chikungunya Vaccine (Live): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Chikungunya Vaccine (Live). Risk X: Avoid

Chloramphenicol (Ophthalmic): May increase adverse/toxic effects of Myelosuppressive Agents. Risk C: Monitor

Chloramphenicol (Systemic): Myelosuppressive Agents may increase myelosuppressive effects of Chloramphenicol (Systemic). Risk X: Avoid

Cladribine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Cladribine. Risk X: Avoid

CloZAPine: Myelosuppressive Agents may increase adverse/toxic effects of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor

Coccidioides immitis Skin Test: Coadministration of Immunosuppressants (Therapeutic Immunosuppressant Agents) and Coccidioides immitis Skin Test may alter diagnostic results. Management: Consider discontinuing therapeutic immunosuppressants several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider Therapy Modification

COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor

COVID-19 Vaccine (mRNA): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider Therapy Modification

COVID-19 Vaccine (Subunit): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of COVID-19 Vaccine (Subunit). Risk C: Monitor

Deferiprone: Myelosuppressive Agents may increase neutropenic effects of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider Therapy Modification

Dengue Tetravalent Vaccine (Live): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Dengue Tetravalent Vaccine (Live). Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Denosumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Denosumab. Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and immunosuppressants. If combined, monitor for signs/symptoms of serious infections. Risk D: Consider Therapy Modification

Deucravacitinib: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Dinutuximab Beta: Immune Globulins may decrease therapeutic effects of Dinutuximab Beta. Risk X: Avoid

Efgartigimod Alfa: May decrease therapeutic effects of Fc Receptor-Binding Agents. Risk C: Monitor

Etrasimod: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Fexinidazole: Myelosuppressive Agents may increase myelosuppressive effects of Fexinidazole. Risk X: Avoid

Filgotinib: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid

Inebilizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Inebilizumab. Risk C: Monitor

Influenza Virus Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating immunosuppressants if possible. If vaccination occurs less than 2 weeks prior to or during therapy, revaccinate 2 to 3 months after therapy discontinued if immune competence restored. Risk D: Consider Therapy Modification

Leflunomide: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents. Risk D: Consider Therapy Modification

Linezolid: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Nadofaragene Firadenovec: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid

Natalizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Natalizumab. Risk X: Avoid

Nipocalimab: May decrease therapeutic effects of Fc Receptor-Binding Agents. Risk C: Monitor

Ocrelizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ocrelizumab. Risk C: Monitor

Ofatumumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ofatumumab. Risk C: Monitor

Olaparib: Myelosuppressive Agents may increase myelosuppressive effects of Olaparib. Risk C: Monitor

Pidotimod: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Pidotimod. Risk C: Monitor

Pimecrolimus: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Pimecrolimus. Risk X: Avoid

Pneumococcal Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Pneumococcal Vaccines. Risk C: Monitor

Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Polymethylmethacrylate: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase hypersensitivity effects of Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider Therapy Modification

Promazine: May increase myelosuppressive effects of Myelosuppressive Agents. Risk C: Monitor

Rabies Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider Therapy Modification

Ritlecitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ritlecitinib. Risk X: Avoid

Ropeginterferon Alfa-2b: Myelosuppressive Agents may increase myelosuppressive effects of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider Therapy Modification

Rozanolixizumab: May decrease therapeutic effects of Fc Receptor-Binding Agents. Risk C: Monitor

Ruxolitinib (Topical): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ruxolitinib (Topical). Risk X: Avoid

Sipuleucel-T: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants prior to initiating sipuleucel-T therapy. Risk D: Consider Therapy Modification

Sphingosine 1-Phosphate (S1P) Receptor Modulators: May increase immunosuppressive effects of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk C: Monitor

Tacrolimus (Topical): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Tacrolimus (Topical). Risk X: Avoid

Talimogene Laherparepvec: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid

Tertomotide: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Tertomotide. Risk X: Avoid

Tofacitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Tofacitinib. Management: Coadministration of tofacitinib with potent immunosuppressants is not recommended. Use with non-biologic disease-modifying antirheumatic drugs (DMARDs) was permitted in psoriatic arthritis clinical trials. Risk X: Avoid

Typhoid Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Typhoid Vaccine. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Ublituximab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Ublituximab. Risk C: Monitor

Upadacitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase immunosuppressive effects of Upadacitinib. Risk X: Avoid

Vaccines (Live): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Vaccines (Live). Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Vaccines (Non-Live/Inactivated/Non-Replicating): Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting immunosuppressants when possible. Patients vaccinated less than 14 days before or during therapy should be revaccinated at least 2 to 3 months after therapy is complete. Risk D: Consider Therapy Modification

Yellow Fever Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Yellow Fever Vaccine. Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Risk X: Avoid

Zoster Vaccine (Live/Attenuated): Immunosuppressants (Therapeutic Immunosuppressant Agents) may increase adverse/toxic effects of Zoster Vaccine (Live/Attenuated). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may decrease therapeutic effects of Zoster Vaccine (Live/Attenuated). Risk X: Avoid

Reproductive Considerations

Females of reproductive potential should use effective contraception during and for at least 3 months following treatment.

Antithymocyte globulin (rabbit) has been used as for the induction of immunosuppression in patients undergoing uterine transplant; a minimum interval of 3 months between uterine transplant and embryo transfer is suggested (Johannesson 2019; Jones 2019).

Pregnancy Considerations

Antithymocyte globulin (rabbit) is a purified immunoglobulin G. Placental transfer of human IgG is dependent upon the IgG subclass, maternal serum concentrations, newborn birth weight, and gestational age, generally increasing as pregnancy progresses. The lowest exposure would be expected during the period of organogenesis (Palmeira 2012; Pentsuk 2009).

Information related to the use of antithymocyte globulin (rabbit) during pregnancy is limited (Balaha 2019; Kutzler 2016; López 2014; Massenkeil 2016).

Transplant Pregnancy Registry International (TPR) is a registry that follows pregnancies that occur in maternal transplant recipients or those fathered by male transplant recipients. The TPR encourages reporting of pregnancies following solid organ transplant by contacting them at 1-877-955-6877 or https://www.transplantpregnancyregistry.org.

Breastfeeding Considerations

It is not known if antithymocyte globulin (rabbit) is present in breast milk.

Because other immunoglobulins are present in breast milk, the manufacturer recommends that breastfeeding be discontinued during antithymocyte globulin (rabbit) therapy.

Monitoring Parameters

Lymphocyte count (total lymphocyte and/or T-cell subset), CBC with differential and platelet count; vital signs during administration; signs and symptoms of infection

Solid organ transplant: Absolute CD3 count (cells/µL) monitoring and CD3 based dosing has been considered in kidney and heart transplant recipients. It may be beneficial in certain patient populations but is not routinely recommended or utilized. Dose adjustments have been recommended based on the CD3 count (Krasinskas 2002; Peddi 2002; Uber 2004).

Mechanism of Action

Antithymocyte globulin (rabbit) is a polyclonal antibody which appears to cause immunosuppression by acting on T-cell surface antigens and depleting CD4 lymphocytes

Pharmacokinetics (Adult Data Unless Noted)

Onset of action (T-cell depletion): Within 24 hours (Hardinger 2006)

Duration: Lymphopenia may persist for up to 1 year (Hardinger 2006)

Half-life elimination: 2 to 3 days

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Thymoglobuline;
  • (AT) Austria: Thymoglobuline;
  • (AU) Australia: Atg rabbit;
  • (BE) Belgium: Thymoglobuline;
  • (BG) Bulgaria: Thymoglobuline;
  • (BR) Brazil: Thymoglobuline;
  • (CH) Switzerland: Atg | Thymoglobuline;
  • (CN) China: Anti human t lymphocyte rabbit immunoglobulin | Rabbit anti human thymocyte immunoglobulin | Thymoglobuline;
  • (CO) Colombia: Timoglobulina;
  • (CZ) Czech Republic: Atg | Thymoglobulin;
  • (DE) Germany: Atg | Thymoglobulin | Thymoglobuline;
  • (EC) Ecuador: Timoglobulina;
  • (EE) Estonia: Thymoglobuline;
  • (EG) Egypt: Thymoglobulin | Thymoglobuline;
  • (ES) Spain: Timoglobulina;
  • (FI) Finland: Thymoglobuline;
  • (FR) France: Thymoglobuline;
  • (GB) United Kingdom: Thymoglobuline;
  • (GR) Greece: Thymoglobuline;
  • (HK) Hong Kong: Thymoglobuline;
  • (HR) Croatia: Thymoglobuline;
  • (HU) Hungary: Thymoglobulin;
  • (IE) Ireland: Thymoglobuline;
  • (IT) Italy: Thymoglobuline;
  • (JO) Jordan: Thymoglobulin;
  • (JP) Japan: Thymoglobulin | Thymoglobuline;
  • (KR) Korea, Republic of: Thymoglobulin;
  • (KW) Kuwait: Thymoglobuline;
  • (LB) Lebanon: Thymoglobuline;
  • (LT) Lithuania: Atg;
  • (LV) Latvia: Thymoglobuline;
  • (MX) Mexico: Timoglobulina;
  • (MY) Malaysia: Thymoglobuline;
  • (NL) Netherlands: Thymoglobuline;
  • (NZ) New Zealand: Thymoglobuline;
  • (PE) Peru: Timoglobulina;
  • (PK) Pakistan: Thymoglobuline;
  • (PL) Poland: Thymoglobuline;
  • (PT) Portugal: Timoglobulina;
  • (QA) Qatar: Thymoglobuline;
  • (RU) Russian Federation: Atg-Fresenius S | Thymoglobulin;
  • (SA) Saudi Arabia: Thymoglobulin;
  • (SE) Sweden: Thymoglobuline;
  • (SI) Slovenia: Thymoglobulin;
  • (SK) Slovakia: Thymoglobuline;
  • (TH) Thailand: Thymoglobuline;
  • (TN) Tunisia: Thymoglobuline;
  • (TR) Turkey: Thymoglobuline;
  • (TW) Taiwan: Thymoglobuline;
  • (UY) Uruguay: Timoglobulina;
  • (ZA) South Africa: Thymoglobuline
  1. Admiraal R, van Kesteren C, Jol-van der Zijde CM, et al. Association between anti-thymocyte globulin exposure and CD4+ immune reconstitution in paediatric haemopoietic cell transplantation: a multicentre, retrospective pharmacodynamic cohort analysis. Lancet Haematol. 2015;2(5):e194-203. [PubMed 26688094]
  2. Alloway RR, Woodle ES, Abramowicz D, et al. Rabbit anti-thymocyte globulin for the prevention of acute rejection in kidney transplantation. Am J Transplant. 2019;19(8):2252-2261. doi:10.1111/ajt.15342 [PubMed 30838775]
  3. Ansari D, Lund LH, Stehlik J, et al. Induction with anti-thymocyte globulin in heart transplantation is associated with better long-term survival compared with basiliximab. J Heart Lung Transplant. 2015;34(10):1283-1291. doi:10.1016/j.healun.2015.04.001 [PubMed 26087667]
  4. Aversa F, Terenzi A, Tabilio A, et al. Full haplotype-mismatched hematopoietic stem-cell transplantation: a phase II study in patients with acute leukemia at high risk of relapse. J Clin Oncol. 2005;23(15):3447-3454. [PubMed 15753458]
  5. Aziz F, Parajuli S, Uddin S, et al. How should pancreas transplant rejection be treated?. Transplantation. 2019;103(9):1928-1934. doi:10.1097/TP.0000000000002694 [PubMed 31233481]
  6. Balaha M, Al-Otaibi T, Gheith OA, et al. Thymoglobulin-resistant t-cell-mediated acute rejection in a pregnant renal transplant recipient: case report and review of the literature. Exp Clin Transplant. 2019;17(Suppl 1):159‐163. doi:10.6002/ect.MESOT2018.P38 [PubMed 30777545]
  7. Barros N, Sharfuddin AA, Powelson J, et al. Rabbit anti-thymocyte globulin administration to treat rejection in simultaneous pancreas and kidney transplant recipients with recent COVID-19 infection. Clin Transplant. 2021;35(2):e14149. doi:10.1111/ctr.14149 [PubMed 33179350]
  8. Bazerbachi F, Selzner M, Boehnert MU, et al. Thymoglobulin versus basiliximab induction therapy for simultaneous kidney-pancreas transplantation: impact on rejection, graft function, and long-term outcome. Transplantation. 2011;92(9):1039-1043. doi:10.1097/TP.0b013e3182313e4f [PubMed 22002345]
  9. Bazerbachi F, Selzner M, Marquez MA, et al. Pancreas-after-kidney versus synchronous pancreas-kidney transplantation: comparison of intermediate-term results. Transplantation. 2013;95(3):489-494. doi:10.1097/TP.0b013e318274ab1a [PubMed 23183776]
  10. Bogetti D, Sankary HN, Jarzembowski TM, et al. Thymoglobulin induction protects liver allografts from ischemia/reperfusion injury. Clin Transplant. 2005;19(4):507-511. doi:10.1111/j.1399-0012.2005.00375.x [PubMed 16008596]
  11. Boillot O, Seket B, Dumortier J, et al. Thymoglobulin induction in liver transplant recipients with a tacrolimus, mycophenolate mofetil, and steroid immunosuppressive regimen: a five-year randomized prospective study. Liver Transpl. 2009;15(11):1426-1434. [PubMed 19877264]
  12. Bond GJ, Mazariegos GV, Sindhi R, Abu-Elmagd KM, Reyes J. Evolutionary experience with immunosuppression in pediatric intestinal transplantation. J Pediatr Surg. 2005;40(1):274-279; discussion 279-280. [PubMed 15868597]
  13. Brennan DC, Flavin K, Lowell JA, et al. A randomized, double-blinded comparison of Thymoglobulin versus Atgam for induction immunosuppressive therapy in adult renal transplant recipients [published correction appears in Transplantation. 1999;67(10):1386]. Transplantation. 1999;67(7):1011-1018. [PubMed 10221486]
  14. Broliden PA, Dahl IM, Hast R, et al, “Antithymocyte Globulin and Cyclosporine A as Combination Therapy for Low-Risk Non-Sideroblastic Myelodysplastic Syndromes,” Haematologica, 2006, 91(5):667-70. [PubMed 16670072]
  15. Bubalo J, Carpenter PA, Majhail N, et al. Conditioning chemotherapy dose adjustment in obese patients: a review and position statement by the American Society for Blood and Marrow Transplantation practice guideline committee. Biol Blood Marrow Transplant. 2014;20(5):600-616. [PubMed 24462742]
  16. Charpentier B, Rostaing L, Berthoux F, et al. A three-arm study comparing immediate tacrolimus therapy with antithymocyte globulin induction therapy followed by tacrolimus or cyclosporine A in adult renal transplant recipients. Transplantation. 2003;75(6):844-851. [PubMed 12660513]
  17. Di Bona E, Rodeghiero F, Bruno B, et al. Rabbit antithymocyte globulin (r-ATG) plus cyclosporine and granulocyte colony stimulating factor is an effective treatment for aplastic anaemia patients unresponsive to a first course of intensive immunosuppressive therapy. Gruppo Italiano Trapianto di Midollo Osseo (GITMO). Br J Haematol. 1999;107(2):330-334. [PubMed 10583220]
  18. Di Filippo S, Boissonnat P, Sassolas F, et al, “Rabbit Antithymocyte Globulin as Induction Immunotherapy in Pediatric Heart Transplantation,” Transplantation, 2003, 75(3):354-8. [PubMed 12589158]
  19. Duhart BT Jr, Ally WA, Krauss AG, et al. The benefit of sirolimus maintenance immunosuppression and rabbit antithymocyte globulin induction in liver transplant recipients that develop acute kidney injury in the early postoperative period. J Transplant. 2015;2015:926168. doi:10.1155/2015/926168 [PubMed 25861462]
  20. Eason JD, Loss GE, Blazek J, Nair S, Mason AL. Steroid-free liver transplantation using rabbit antithymocyte globulin induction: results of a prospective randomized trial. Liver Transpl. 2001;7(8):693-697. doi:10.1053/jlts.2001.26353 [PubMed 11510013]
  21. Eason JD, Nair S, Cohen AJ, Blazek JL, Loss GE Jr. Steroid-free liver transplantation using rabbit antithymocyte globulin and early tacrolimus monotherapy. Transplantation. 2003;75(8):1396-1399. doi:10.1097/01.TP.0000062834.30922.FE [PubMed 12717237]
  22. Erickson AL, Roberts K, Malek SK, Chandraker AK, Tullius SG, Gabardi S. Analysis of infusion-site reactions in renal transplant recipients receiving peripherally administered rabbit antithymocyte globulin as compared with basiliximab. Transpl Int. 2010;23(6):636-640. doi:10.1111/j.1432-2277.2009.01042.x [PubMed 20074083]
  23. Farney A, Sundberg A, Moore P, et al. A randomized trial of alemtuzumab vs. anti-thymocyte globulin induction in renal and pancreas transplantation. Clin Transplant. 2008;22(1):41-49. doi:10.1111/j.1399-0012.2007.00742.x [PubMed 18217904]
  24. Farney AC, Doares W, Rogers J, et al. A randomized trial of alemtuzumab versus antithymocyte globulin induction in renal and pancreas transplantation. Transplantation. 2009;88(6):810-819. doi:10.1097/TP.0b013e3181b4acfb [PubMed 19920781]
  25. Fridell JA, Mangus RS, Chen JM, et al. Steroid-free three-drug maintenance regimen for pancreas transplant alone: comparison of induction with rabbit antithymocyte globulin +/- rituximab. Am J Transplant. 2018;18(12):3000-3006. doi:10.1111/ajt.14921 [PubMed 29738100]
  26. Gaber AO, First MR, Tesi RJ, et al. Results of the double-blind, randomized, multicenter, phase III clinical trial of Thymoglobulin versus Atgam in the treatment of acute graft rejection episodes after renal transplantation. Transplantation. 1998;66(1):29-37. [PubMed 9679818]
  27. Garcia Aroz S, Tzvetanov I, Hetterman EA, et al. Long-term outcomes of living-related small intestinal transplantation in children: A single-center experience. Pediatr Transplant. 2017;21(4). [PubMed 28295952]
  28. Gondolesi GE. Induction in intestinal transplantation. Transplantation. 2020;104(10):1999-2000. doi:10.1097/TP.0000000000003081 [PubMed 31978039]
  29. Gurk-Turner C, Airee R, Philosophe B, Kukuruga D, Drachenberg C, Haririan A. Thymoglobulin dose optimization for induction therapy in high risk kidney transplant recipients. Transplantation. 2008;85(10):1425-1430. doi:10.1097/TP.0b013e31816dd596 [PubMed 18497682]
  30. Hardinger KL, “Rabbit Antithymocyte Globulin Induction Therapy in Adult Renal Transplantation,” Pharmacotherapy, 2006, 26(12):1771-83. [PubMed 17125438]
  31. Hardinger KL, Rhee S, Buchanan P, et al. A prospective, randomized, double-blinded comparison of thymoglobulin versus Atgam for induction immunosuppressive therapy: 10-year results. Transplantation. 2008;86(7):947-952. [PubMed 18852661]
  32. Hartwig MG, Snyder LD, Appel JZ 3rd, et al. Rabbit anti-thymocyte globulin induction therapy does not prolong survival after lung transplantation. J Heart Lung Transplant. 2008;27(5):547-553. [PubMed 18442722]
  33. Hellemans R, Bosmans JL, Abramowicz D. Induction therapy for kidney transplant recipients: do we still need anti-IL2 receptor monoclonal antibodies? Am J Transplant. 2017;17(1):22-27. doi:10.1111/ajt.13884 [PubMed 27223882]
  34. Hertig A, Zuckermann A. Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update. Transpl Immunol. 2015;32(3):179-187. [PubMed 25936966]
  35. Horan JT, Liesveld JL, Fenton P, et al, “Hematopoietic Stem Cell Transplantation for Multiply Transfused Patients With Sickle Cell Disease and Thalassemia After Low-Dose Total Body Irradiation, Fludarabine, and Rabbit Anti-thymocyte Globulin,” Bone Marrow Transplant, 2005, 35(2):171-7. [PubMed 15531901]
  36. Horn B, Baxter-Lowe LA, Englert L, et al. Reduced intensity conditioning using intravenous busulfan, fludarabine and rabbit ATG for children with nonmalignant disorders and CML. Bone Marrow Transplant. 2006;37(3):263-269. [PubMed 16327813]
  37. Huard G, Schiano TD, Moon J, Iyer K. Severe acute cellular rejection after intestinal transplantation is associated with poor patient and graft survival. Clin Transplant. 2017;31(5):10.1111/ctr.12956. doi:10.1111/ctr.12956 [PubMed 28295657]
  38. Jarmi T, Patel N, Aslam S, et al. Outcomes of induction therapy with rabbit anti-thymocyte globulin in heart transplant recipients: a single center retrospective cohort study. Ann Transplant. 2018;23:422-426. doi:10.12659/AOT.907984 [PubMed 29915167]
  39. Johannesson L, Wall A, Putman JM, Zhang L, Testa G, Diaz-Garcia C. Rethinking the time interval to embryo transfer after uterus transplantation - DUETS (Dallas UtErus Transplant Study). BJOG. 2019;126(11):1305‐1309. doi:10.1111/1471-0528.15860 [PubMed 31286643]
  40. Jones BP, Saso S, Bracewell-Milnes T, et al. Human uterine transplantation: a review of outcomes from the first 45 cases. BJOG. 2019;126(11):1310‐1319. doi:10.1111/1471-0528.15863 [PubMed 31410987]
  41. Jorgenson MR, Descourouez JL, Felix DC, Hanlon BM, Leverson GE, Foley DP. Safety of antithymocyte globulin in patients undergoing liver transplantation with livers from donation after circulatory death donors. Ann Pharmacother. 2019;53(10):981-990. doi:10.1177/1060028019847231 [PubMed 31030529]
  42. Kang HJ, Hong KT, Lee JW, et al. Improved Outcome of a Reduced Toxicity-Fludarabine, Cyclophosphamide, plus Antithymocyte Globulin Conditioning Regimen for Unrelated Donor Transplantation in Severe Aplastic Anemia: Comparison of 2 Multicenter Prospective Studies. Biol Blood Marrow Transplant. 2016;22(8):1455-1459. [PubMed 27090956]
  43. Khositseth S, Matas A, Cook ME, Gillingham KJ, Chavers BM. Thymoglobulin versus ATGAM induction therapy in pediatric kidney transplant recipients: a single-center report. Transplantation. 2005;79(8):958-963. [PubMed 15849550]
  44. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9(suppl 3):S1-S155. doi:10.1111/j.1600-6143.2009.02834.x [PubMed 19845597]
  45. Krasinskas AM, Kreisel D, Acker MA, et al. CD3 monitoring of antithymocyte globulin therapy in thoracic organ transplantation. Transplantation. 2002;73(8):1339-1341. [PubMed 11981432]
  46. Kroemer A, Belyayev L, Khan K, et al. Rejection of intestinal allotransplants is driven by memory T helper type 17 immunity and responds to infliximab. Am J Transplant. 2021;21(3):1238-1254. doi:10.1111/ajt.16283 [PubMed 32882110]
  47. Kröger N, Solano C, Wolschke C, et al. Antilymphocyte Globulin for Prevention of Chronic Graft-versus-Host Disease. N Engl J Med. 2016;374(1):43-53. [PubMed 26735993]
  48. Kutzler HL, Ye X, Rochon C, Martin ST. Administration of antithymocyte globulin (rabbit) to treat a severe, mixed rejection episode in a pregnant renal transplant recipient. Pharmacotherapy. 2016;36(4):e18‐e22. doi:10.1002/phar.1725 [PubMed 26892892]
  49. Lee DH, Zuckerman RA; AST Infectious Diseases Community of Practice. Herpes simplex virus infections in solid organ transplantation: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13526. doi:10.1111/ctr.13526 [PubMed 30859647]
  50. Lee JG, Lee J, Lee JJ, et al. Efficacy of rabbit anti-thymocyte globulin for steroid-resistant acute rejection after liver transplantation. Medicine (Baltimore). 2016;95(23):e3711. doi:10.1097/MD.0000000000003711 [PubMed 27281070]
  51. Li L, Chaudhuri A, Chen A, et al. Efficacy and safety of thymoglobulin induction as an alternative approach for steroid-free maintenance immunosuppression in pediatric renal transplantation. Transplantation. 2010;90(12):1516-1520. [PubMed 20935596]
  52. Locatelli F, Bernardo ME, Bertaina A, et al. Efficacy of two different doses of rabbit anti-T-lymphocyte globulin to prevent graft-versus-host disease in children with haematological malignancies transplanted from an unrelated donor: a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2017;18(8):1126-1136. [PubMed 28705454]
  53. López LF, Martínez CJ, Castañeda DA, Hernández AC, Pérez HC, Lozano E. Pregnancy and kidney transplantation, triple hazard? Current concepts and algorithm for approach of preconception and perinatal care of the patient with kidney transplantation. Transplant Proc. 2014;46(9):3027‐3031. doi:10.1016/j.transproceed.2014.07.013 [PubMed 25420815]
  54. Marczin N, de Waal EEC, Hopkins PMA, et al; Task force Chairs and Writing Group (exclusive of the consensus developing and coordinating group members); Consensus Members (exclusive of the consensus developing and coordinating group or co-chairs and writing group members); Independent Reviewers. International consensus recommendations for anesthetic and intensive care management of lung transplantation. An EACTAIC, SCA, ISHLT, ESOT, ESTS, and AST approved document. J Heart Lung Transplant. 2021;40(11):1327-1348. doi:10.1016/j.healun.2021.07.012 [PubMed 34732281]
  55. Marsh JC, Ball SE, Cavenagh J, et al. Guidelines for the diagnosis and management of aplastic anaemia. Br J Haematol. 2009;147(1):43-70. [PubMed 19673883]
  56. Martinu T, Howell DN, Palmer SM. Acute cellular rejection and humoral sensitization in lung transplant recipients. Semin Respir Crit Care Med. 2010;31(2):179-188. [PubMed 20354931]
  57. Marvin MR, Droogan C, Sawinski D, Cohen DJ, Hardy MA. Administration of rabbit antithymocyte globulin (thymoglobulin) in ambulatory renal-transplant patients. Transplantation. 2003;75(4):488-489. [PubMed 12605115]
  58. Massenkeil G, Alexander T, Rosen O, et al. Long-term follow-up of fertility and pregnancy in autoimmune diseases after autologous haematopoietic stem cell transplantation. Rheumatol Int. 2016;36(11):1563‐1568. doi:10.1007/s00296-016-3531-2 [PubMed 27522225]
  59. Moini M, Schilsky ML, Tichy EM. Review on immunosuppression in liver transplantation. World J Hepatol. 2015;7(10):1355-1368. doi:10.4254/wjh.v7.i10.1355 [PubMed 26052381]
  60. Montenovo MI, Jalikis FG, Li M, et al. Superior patient and graft survival in adult liver transplant with rabbit antithymocyte globulin induction: experience with 595 patients. Exp Clin Transplant. 2017;15(4):425-431. doi:10.6002/ect.2015.0350 [PubMed 27309029]
  61. Nair A, Coromina Hernandez L, Shah S, et al. Induction therapy with antithymocyte globulin and delayed calcineurin inhibitor initiation for renal protection in liver transplantation: a multicenter randomized controlled phase II-B trial. Transplantation. 2022;106(5):997-1003. doi:10.1097/TP.0000000000003904 [PubMed 34319926]
  62. Palmeira P, Quinello C, Silveira-Lessa AL, Zago CA, Carneiro-Sampaio M. IgG placental transfer in healthy and pathological pregnancies. Clin Dev Immunol. 2012;2012:985646. [PubMed 22235228]
  63. Palmer SM, Miralles AP, Lawrence CM, et al. Rabbit antithymocyte globulin decreases acute rejection after lung transplantation: results of a randomized, prospective study. Chest. 1999;116(1):127-133. [PubMed 10424515]
  64. Palmer WC, Taner CB, Keaveny AP, Nakhleh RE, Nguyen JH, Rosser BG Jr. Antithymocyte globulin use for corticosteroid nonresponsive rejection after liver transplantation. Transplant Proc. 2018;50(10):3606-3614. doi:10.1016/j.transproceed.2018.09.001 [PubMed 30577245]
  65. Peddi VR, Bryant M, Roy-Chaudhury P, Woodle ES, First MR. Safety, efficacy, and cost analysis of thymoglobulin induction therapy with intermittent dosing based on CD3+ lymphocyte counts in kidney and kidney-pancreas transplant recipients. Transplantation. 2002;73(9):1514-1518. [PubMed 12023634]
  66. Pennington CA, Tischer SM, Lee E, Lee S, Sindelar J Jr, Park JM. Evaluation of a weight-based rabbit anti-thymocyte globulin induction dosing regimen for kidney transplant recipients. Pharmacotherapy. 2015;35(8):748-754. doi:10.1002/phar.1624 [PubMed 26234282]
  67. Pentsuk N, van der Laan JW. An interspecies comparison of placental antibody transfer: new insights into developmental toxicity testing of monoclonal antibodies. Birth Defects Res B Dev Reprod Toxicol. 2009;86(4):328-344. [PubMed 19626656]
  68. Redfield RR, Kaufman DB, Odorico JS. Diagnosis and treatment of pancreas rejection. Curr Transplant Rep. 2015;2(2):169-175. doi:10.1007/s40472-015-0061-x [PubMed 26000231]
  69. Reyes J, Mazariegos GV, Abu-Elmagd K, et al. Intestinal transplantation under tacrolimus monotherapy after perioperative lymphoid depletion with rabbit anti-thymocyte globulin (thymoglobulin). Am J Transplant. 2005;5(6):1430-1436. [PubMed 15888051]
  70. Ruutu T, Gratwohl A, de Witte T, et al. Prophylaxis and treatment of GVHD: EBMT-ELN working group recommendations for a standardized practice. Bone Marrow Transplant. 2014;49(2):168-173. [PubMed 23892326]
  71. Saidi RF, Hertl M, Chung RT, et al. Induction with rabbit antithymocyte globulin following orthotopic liver transplantation for Hepatitis C. Int J Organ Transplant Med. 2011;2(4):160-165. [PubMed 25013609]
  72. Scheinberg P, Nunez O, Weinstein B, et al. Horse versus rabbit antithymocyte globulin in acquired aplastic anemia. N Engl J Med. 2011;365(5):430-438. [PubMed 21812672]
  73. Scheinberg P, Nunez O, Young NS. Retreatment with rabbit anti-thymocyte globulin and ciclosporin for patients with relapsed or refractory severe aplastic anaemia. Br J Haematol. 2006;133(6):622-627. [PubMed 16704436]
  74. Schmitt TM, Phillips M, Sawyer RG, et al. Anti-thymocyte globulin for the treatment of acute cellular rejection following liver transplantation. Dig Dis Sci. 2010;55(11):3224-3234. [PubMed 20238251]
  75. Singh N, Rossi AP, Savic M, Rubocki RJ, Parker MG, Vella JP. Tailored rabbit antithymocyte globulin induction dosing for kidney transplantation. Transplant Direct. 2018;4(2):e343. doi:10.1097/TXD.0000000000000765 [PubMed 29464204]
  76. Soliman T, Hetz H, Burghuber C, et al. Short-term induction therapy with anti-thymocyte globulin and delayed use of calcineurin inhibitors in orthotopic liver transplantation. Liver Transpl. 2007;13(7):1039-1044. doi:10.1002/lt.21185 [PubMed 17600336]
  77. Soni S, Gross TG, Rangarajan H, Baker KS, Sturm M, Rhodes M. Outcomes of matched sibling donor hematopoietic stem cell transplantation for severe sickle cell disease with myeloablative conditioning and intermediate-dose of rabbit anti-thymocyte globulin. Pediatr Blood Cancer. 2014;61(9):1685-1689. [PubMed 24740582]
  78. Starzl TE, Murase N, Abu-Elmagd K, et al, “Tolerogenic Immunosuppression for Organ Transplantation,” Lancet, 2003, 361(9368):1502-10. [PubMed 12737859]
  79. Stegall MD, Kim DY, Prieto M, et al. Thymoglobulin induction decreases rejection in solitary pancreas transplantation. Transplantation. 2001;72(10):1671-1675. doi:10.1097/00007890-200111270-00017 [PubMed 11726830]
  80. Takahashi Y, Muramatsu H, Sakata N, et al. Rabbit antithymocyte globulin and cyclosporine as first-line therapy for children with acquired aplastic anemia. Blood. 2013;121(5):862-863. [PubMed 23372154]
  81. Thangarajah D, O'Meara M, Dhawan A. Management of acute rejection in paediatric liver transplantation. Paediatr Drugs. 2013;15(6):459-471. [PubMed 23925711]
  82. Thymoglobulin (anti-thymocyte globulin [rabbit]) [prescribing information]. Cambridge, MA: Genzyme Corporation; March 2023.
  83. Trevizol AP, David AI, Dias ER, Mantovani D, Pécora R, D'Albuquerque LA. Intestinal and multivisceral transplantation immunosuppression protocols--literature review. Transplant Proc. 2012;44(8):2445-2448. [PubMed 23026616]
  84. Trissel LA and Saenz CA, “Physical Compatibility of Antithymocyte Globulin (Rabbit) With Heparin Sodium and Hydrocortisone Sodium Succinate,” Am J Health Syst Pharm, 2003, 60(16):1650-2. [PubMed 12966908]
  85. Trofe-Clark J, Reese PP, Patel HJ, et al. Efficacy and safety of extended-duration inpatient-to-outpatient rabbit antithymocyte globulin induction in de novo kidney transplant recipients: 6-month outcomes. Transplantation. 2012;94(5):506-512. [PubMed 22895613]
  86. Trofe J, Stratta RJ, Egidi MF, et al. Thymoglobulin for induction or rejection therapy in pancreas allograft recipients: a single centre experience. Clin Transplant. 2002;16(suppl)7:34-44. doi:10.1034/j.1399-0012.16.s7.5.x [PubMed 12372042]
  87. Uber WE, Uber LA, VanBakel AB, et al. CD3 monitoring and thymoglobulin therapy in cardiac transplantation: clinical outcomes and pharmacoeconomic implications. Transplant Proc. 2004;36(10):3245-3249. doi:10.1016/j.transproceed.2004.11.099 [PubMed 15686739]
  88. Vacha M, Gommer J, Rege A, Sanoff S, Sudan D, Harris M. Effects of ideal versus total body weight dosage of rabbit antithymocyte globulin on outcomes of kidney transplant patients with high immunologic risk. Exp Clin Transplant. 2016;14(5):511-517. doi:10.6002/ect.2015.0197 [PubMed 26742693]
  89. Velleca A, Shullo MA, Dhital K, et al. The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2023;42(5):e1-e141. doi:10.1016/j.healun.2022.10.015 [PubMed 37080658]
  90. Vianna R, Farag A, Gaynor JJ, et al. Association of more intensive induction with less acute rejection following intestinal transplantation: results of 445 consecutive cases from a single center. Transplantation. 2020;104(10):2166-2178. doi:10.1097/TP.0000000000003074 [PubMed 31929425]
  91. Vianna RM, Mangus RS, Fridell JA, Weigman S, Kazimi M, Tector J. Induction immunosuppression with thymoglobulin and rituximab in intestinal and multivisceral transplantation. Transplantation. 2008;85(9):1290-1293. [PubMed 18475186]
  92. Walker I, Panzarella T, Couban S, et al. Pretreatment with anti-thymocyte globulin versus no anti-thymocyte globulin in patients with haematological malignancies undergoing haemopoietic cell transplantation from unrelated donors: a randomised, controlled, open-label, phase 3, multicentre trial. Lancet Oncol. 2016;17(2):164-173. [PubMed 26723083]
  93. Whitson BA, Kilic A, Lehman A, et al. Impact of induction immunosuppression on survival in heart transplant recipients: a contemporary analysis of agents. Clin Transplant. 2015;29(1):9-17. doi:10.1111/ctr.12469 [PubMed 25284138]
  94. Willemsen L, Jol-van der Zijde CM, Admiraal R, et al. Impact of serotherapy on immune reconstitution and survival outcomes after stem cell transplantations in children: thymoglobulin versus alemtuzumab. Biol Blood Marrow Transplant. 2015;21(3):473-482. [PubMed 25485863]
  95. Yoo MC, Vanatta JM, Modanlou KA, et al. Steroid-free liver transplantation using rabbit antithymocyte globulin induction in 500 consecutive patients. Transplantation. 2015;99(6):1231-1235. doi:10.1097/TP.0000000000000477 [PubMed 25539464]
  96. Yoshimi A, Niemeyer CM, Führer MM, Strahm B. Comparison of the efficacy of rabbit and horse antithymocyte globulin for the treatment of severe aplastic anemia in children. Blood. 2013;121(5):860-861. [PubMed 23372153]
  97. Zuckermann A, Schulz U, Deuse T, et al. Thymoglobulin induction in heart transplantation: patient selection and implications for maintenance immunosuppression. Transpl Int. 2015;28(3):259-269. [PubMed 25363471]
Topic 10026 Version 259.0