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Cost-Savings Realized Using Rabbit Anti-Thymocyte Globulin Ideal Body Weight Dosing for Kidney Transplantation
Christy Ilia1, Ciara Walshe1,2, Linh Nguyen1,2
1Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Progress in Transplantation (Aliso Viejo, Calif.)
|June 4, 2026
Summary
Using ideal body weight for rabbit anti-thymocyte globulin (rATG) dosing in kidney transplant recipients saves money and does not negatively impact patient outcomes. This strategy offers significant cost savings for drug purchasing without compromising clinical results.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pharmacoeconomics
Background:
- Optimal dosing strategies for rabbit anti-thymocyte globulin (rATG) in kidney transplant recipients remain under investigation.
- Current practices often utilize actual body weight for rATG dosing, potentially leading to suboptimal cost-effectiveness.
- Evaluating alternative dosing strategies like ideal body weight (IBW) is crucial for optimizing resource allocation in transplantation.
Purpose of the Study:
- To compare the economic impact and clinical outcomes of ideal body weight-based versus actual body weight-based rATG dosing.
- To determine the cost savings associated with IBW-based rATG dosing in kidney transplant recipients.
- To assess the effect of different rATG dosing strategies on key clinical outcomes, including rejection and infection rates.
Main Methods:
- A retrospective, single-center chart review was conducted on kidney transplant recipients who received rATG induction.
- Two cohorts were analyzed: one receiving actual body weight-based dosing (May 2019-Mar 2020) and another receiving IBW-based dosing (May 2022-Mar 2023).
- Primary endpoint: rATG drug cost per transplant recipient (Average Wholesale Price). Secondary endpoints: biopsy-proven acute rejection, infection-related readmissions, myelosuppression, and viral infections.
Main Results:
- IBW-based rATG dosing resulted in a median cost saving of $3838 per kidney transplant recipient compared to actual body weight-based dosing (P=.02).
- Secondary outcomes, including acute rejection and infection readmissions, were similar between the two dosing groups.
- A statistically significant difference in Epstein-Barr virus viremia was observed (P=.017), but this did not translate to increased infection-related readmissions (P=.226).
Conclusions:
- Implementing an ideal body weight-based dosing protocol for rabbit anti-thymocyte globulin can achieve substantial drug purchasing cost savings.
- This dosing strategy is estimated to save approximately $900,000 annually at an institution performing 250 kidney transplants per year.
- Ideal body weight-based rATG dosing can be adopted without compromising early clinical outcomes in kidney transplant recipients.
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