Infection Risks With Thymoglobulin Use for Delayed Graft Function in Deceased Donor Kidney Transplantation: Research Letter

Anti-thymocyte globulin (ATG) is often used when delayed graft function (DGF) occurs post-transplantation. The ATG may be associated with an increased risk of infections but may also decrease rejection risk in high-immunological risk recipients. The safety of ATG for the indication of DGF in low-immunological risk recipients has not been well characterized. We conducted a retrospective cohort study of deceased donor kidney transplant recipients deemed low-immunological risk and not planned for ATG induction, from June 2019 to June 2023 (N = 139). Participants switched to ATG post-transplant due to DGF (exposure; N = 68) were compared to those who did not receive ATG for induction (controls; N = 71 basiliximab only induction). Outcomes examined included BK, cytomegalovirus (CMV), and serious infection as well as acute rejection, graft loss, and death. Participants who received ATG for DGF, compared to controls, were older (63.9 vs 59.7 years), more often had diabetes as cause of kidney failure (45.5% vs 33.8%) were more often recipients of death determination by circulatory criteria donor (70.5% vs 30.9%) and extended criteria donor kidneys (48.5% vs 32.3%). There was no significant difference in the probability of BK (22.1% vs 21.1%, <i>P</i> = .89), CMV (20.6% vs 9.9%, <i>P</i> = .08), serious infections (44.1% vs 43.6%, <i>P</i> = .96), acute rejection, graft loss, or death. The use of ATG for DGF following kidney transplantation did not significantly increase infection risk nor did it improve graft outcomes. Further studies are needed to clarify the risk-benefit trade-off of using ATG for DGF.