Peripheral administration of antithymocyte globulins: a review of current literature

Antithymocyte globulin (ATG) preparations are purified gamma-immune globulin products used for the prevention and treatment of transplant organ rejection. Manufacturer labeling recommends administration of the currently available ATG preparations (rabbit antithymocyte globulin and equine antithymocyte globulin) via a high-flow vein; typically this is achieved through a central line. The necessity of maintaining central-line access may delay or prevent the administration of these products and place patients at increased risk of morbidity. Currently, there is limited information on the peripheral administration of ATG preparations. However, data suggest that peripheral administration of ATG is both safe and well tolerated. Peripheral administration of ATG may allow for stable low-risk patients to transition to the outpatient setting, thereby, reducing costs and risks associated with hospitalization. This article reviews the available literature on the safety of peripheral administration of ATG preparations, the clinical considerations, and potential economic implications.