Introduction: Polyclonal antibodies like Anti T-Lymphocyte Globulin (ATLG) and Anti-Thymocyte Globulin are frequently employed in solid organ transplant recipients. However, there remains a need to establish standardized protocols for the utilization and dosing of ATLG, specifically in Indian patients. This analysis aims to present our clinical observations and experiences regarding the use of ATLG in kidney transplant recipients.
Aim and Objective: This study aims to evaluate the impact of anti-T  lymphocyte globulin (ATLG) on immunosuppression efficacy and organ survival.
Material and Method: In this retrospective cohort study design, the medical records of kidney transplant recipients who received ATLG as an induction agent (n = 125, mean age 44.8±13.6 years, males 71%), were reviewed. The immunosuppression efficacy was assessed by evaluating the survival rates after a mean follow-up duration of 52 weeks. Secondary outcomes encompass infectious complications, renal function parameters, and adverse events associated with ATLG administration. Descriptive statistics summarized the patient characteristics and transplant-related variables. Chi-square tests are used to compare categorical variables, and Student's t-tests for all continuous variables.
Result: The study revealed a patient survival rate of 95.2% (n = 119) over a mean follow-up period of 12 months. Among the six patients who expired post-transplant, causes included acute liver failure (n=1, 1.08%), antibody-mediated rejection (ABMR) (n=1,0.8%), and COVID-19 pneumonia (n=4, 3.2%). Post-transplant renal function remained stable, with serum creatinine levels within the normal range. The most common reasons for re-admission included urinary tract infection (n=8,6.4% ;predominantly E. coli), leucopenia (n=2, 1.6%), acute liver injury (n=1, 0.8%), acute tubular necrosis (n=1, 0.8%), and azotemia (n=1, 0.8%). Post-transplant pneumonia cases totaled seven, with Klebsiella (n=5, 4%).  Overall rejection occurred in n=12, 9.6% of cases, with n=7, 5.6% classified as cellular-mediated rejections and n=5, 4% as antibody-mediated. Anti-T-Lymphocyte Globulin (ATLG) induction demonstrated a statistically significant reduction in Absolute lymphocyte count, Absolute CD3, Absolute CD4, Absolute CD8, and CD4/CD8 ratio (p<0.0001). These findings underscore ATLG's efficacy in providing adequate immunosuppression while ensuring a favorable overall survival rate among kidney transplant recipients.
Conclusion: Through the comprehensive assessment of Anti-T-Lymphocyte Globulin's (ATLG) influence on immunosuppression efficacy and organ survival in kidney transplant recipients, this study endeavors to provide essential insights aimed at refining transplant management strategies and improving patient outcomes.