Impact of Peripheral Rabbit Anti-Thymocyte Globulin Without Heparin and Hydrocortisone Additives on Local Infusion Reactions

Background: Rabbit anti-thymocyte globulin (rATG) is indicated for induction immunosuppression therapy in renal transplant recipients. Heparin and hydrocortisone are standardly added to peripheral rATG preparations to reduce the incidence of local infusion reactions. In March 2023, this institution removed heparin and hydrocortisone additives in peripheral rATG preparations to avoid medication waste in the setting of drug shortages. Objective: The purpose of this study was to compare the incidence of local infusion reactions in renal transplant recipients receiving peripheral rATG with and without additives. Methods: This was a single-center, retrospective, pre- and post-implementation cohort study of adult renal transplant recipients. Patients were included if they were ≥18 years of age, received rATG through a peripheral line, and received a renal transplant between November 1, 2022 and July 12, 2023, inclusive. The primary outcome was the incidence of local infusion reactions. Descriptive statistics were used to report baseline demographics and a Fisher’s exact test was used to compare rates of local infusion reactions in the additives and no additives groups. Results: A total of 261 peripheral rATG doses were included in the analysis. The baseline characteristics were similar between the two groups. Of the 261 rATG infusions, 120 infusions included heparin and hydrocortisone in the preparation, while 141 of the infusions did not contain additives. The difference between groups in occurrence of local infusion reactions was not statistically significant. Local infusion reactions were reported during ten (8.3%) rATG infusions with additives compared to eight (5.7%) rATG infusions without additives ( P = .398). Conclusion: Renal transplant recipients receiving rATG induction therapy without heparin and hydrocortisone additives via peripheral infusion had a similar incidence of local infusion reactions compared to those with additives. Additional studies are needed to substantiate these findings.