Cost-Savings Realized Using Rabbit Anti-Thymocyte Globulin Ideal Body Weight Dosing for Kidney Transplantation Induction Immunosuppression.

The study was retrospective and patients were not matched, so baseline differences may have influenced the results. The two eras differed in race distribution, cold ischemia time, delayed graft function, and availability of steroid-sparing regimens, which makes it hard to attribute outcomes only to dosing. It was a single-center review using average wholesale price, so other centers with negotiated discounts may see different savings. Only 6-month outcomes were assessed, and long-term graft or patient outcomes were not measured. Some chart data could have been missing, although endpoints were assessed as present or absent. Patients whose ideal body weight exceeded actual body weight were excluded, so the comparison applies only to recipients where ideal body weight was not higher than actual body weight. The number of rabbit anti-thymocyte globulin doses varied, and more Black/non-Hispanic recipients in the ideal body weight cohort received 4 doses, which may have affected cost and exposure. Maintenance medications may have been adjusted during follow-up, so some low blood counts or viral findings could be related to other drugs rather than dosing alone.

The authors received no financial support. They declared potential conflicts of interest, but no specific conflicts are stated.

Do not conclude ideal body weight dosing is proven safe in all transplant centers. The study was retrospective, single-center, not matched, and only followed patients for 6 months; ideal body weight dosing was linked to higher Epstein-Barr virus viremia, and delayed graft function differences were confounded by longer cold ischemia time.