Comparison of Anti-human T-lymphocyte Immunoglobulin (r-ATLG) vs. Anti-thymocyte Globulin (r-ATG) as Induction Agents in Kidney Transplantation: A 5-Year Retrospective, Single-Center, Observational Study

Background: T cell depletion agents, Anti-Thymocyte Globulin (r-ATG) and Anti-Human T-Lymphocyte Immunoglobulin (r-ATLG), are routinely employed as induction therapies in kidney transplantation. This study systematically evaluates the short-term and long-term outcomes of kidney transplants at our center, focusing on the comparative efficacy and safety profiles of these agents. Methods: This retrospective cohort study analyzed data from kidney transplant recipients treated at a tertiary care hospital in India between 2017 and 2024. A total of 603 patients were included, with 381 receiving ATG and 222 receiving ATLG as induction therapy. All patients were maintained on a standard regimen of triple immunosuppressive therapy. Follow-up assessments included evaluations for graft rejection, infections, development of de novo diseases, and overall graft survival Results: The mean follow-up duration was 60 months. The mean doses administered were 5.4 ± 1.4 mg/kg for ATLG and 2.37 ± 1.2 mg/kg for ATG. Baseline demographic and clinical characteristics were well-matched between the two groups. HLA matching showed <3/6 in 95 patients (42.7%) with ATLG and in 318 patients (83.4%) with ATG, while >3/6 HLA matching was found in 127 patients (57.2%) with ATLG and 63 patients (16.5%) with ATG. Serum creatinine levels at discharge and during follow-up intervals were comparable between groups. The incidence of de novo diseases was higher in the ATG group (12 cases, 3.1%) compared to the ATLG group (3 cases, 1.3%). However, the incidence of infections was similar between the two groups. Conclusion: Both ATG and ATLG demonstrated similar efficacy in terms of short-term and long-term graft rejection rates in kidney transplant recipients.Rejection Analysis between (ATLG and ATG)