Aim: The present is a prospective study focussing on the use of absolute lymphocyte count (ALC) in determining the dosage of induction agent in kidney transplant recipients(KTR).
Methodology: The present study was conducted over a period of 12 months. A total of 42 patients receiving rabbit Antithymocyte Globulin (rATG)as induction agent were enrolled.The KTR received first dose (1 mg/kg) on the day of kidney transplant. Subsequent doses were determined according to ALC. The mean ALC of 500 cells/uLwas kept as cut off to determine the dose. ALC was followed until the stable graft function (Serum creatinine-<1.2mg/dL). The patients were put on triple immunosuppressive regimen (Steroid +Tacrolimus+ Mycophenolate Mofetil). The maintenance dosage were kept according to standard therapeutic levels. The patients were discharged on Post operative day seven and subsequent followed on monthly basis till six months.
Results: The mean age of KTR was 46 SD 4 years. The male to female ratio of KTR was 1.2:1. Out of 42 KTR, 16 were received rATG-2 mg/kg and  26 were received rATG-3 mg/kg as per the ALC. The KTR receiving rATG-2 mg/kg, 91.6% had stable graft function on discharge,86.1% had stable graft function at 3 months follow up and 80.5% had stable graft function at 6 months follow up. The KTR receiving rATG-3 mg/kg, 95.2 % had stable graft function on discharge and 92.8 % had stable graft function at 3 months follow up and 85.7% had stable graft function at 6 months follow up. The incidence of acute and chronic rejection was insignificant (P>0.05) in both the groups. The KTR were further assessed regarding the incidence of infections including urinary tract infection, pneumonia, CMV viremia and any other infection. The KTR receiving r ATG 2 mg/kg have a lower incidence of infections as compared to those receiving rATG-3 mg/kg.
Discussion: In routine clinical practice, immunological risk profile based on HLA mismatch, exposure to blood products, multiple pregnancies, native kidney disease are used to categorise the KTR under high and low risk. The dosage of induction agent is further decided  on the basis of risk profile. ALC is a hematological parameter determining the immunological status. ALC can be used as an effective marker to determine the immunological status in immediate KTR and hence, the dosage of induction agent.
Conclusion: The present study focuses on the use of ALC as an easy bedside tool in determining the dosage of induction agent in KTR. Reduced dosage of induction agent decreases the risk of infections and minimises the cost of kidney transplant. The above study is on limited sample size and further studies are needed to fix the value of ALC in determining the dosage of induction agent in KTR.