Relationship between antithymocyte globulin, T cell phenotypes, and clinical outcomes in pediatric kidney transplantation

Brian I. Shaw, Hui Jie Lee, Cliburn Chan, Robert Ettenger, Paul Grimm, Meghan Pearl, Elaine F. Reed, Mark A. Robien, Minnie Sarwal, Linda Stempora, Barry Warshaw, Congwen Zhao, Olivia M. Martinez, Allan D. Kirk, Eileen T. Chambers*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Depletional induction using antithymocyte globulin (ATG) reduces rates of acute rejection in adult kidney transplant recipients, yet little is known about its effects in children. Using a longitudinal cohort of 103 patients in the Immune Development in Pediatric Transplant (IMPACT) study, we compared T cell phenotypes after ATG or non-ATG induction. We examined the effects of ATG on the early clinical outcomes of alloimmune events (development of de novo donor specific antibody and/or biopsy proven rejection) and infection events (viremia/viral infections). Long-term patient and graft outcomes were examined using the Scientific Registry of Transplant Recipients. After ATG induction, although absolute counts of CD4 and CD8 T cells were lower, patients had higher percentages of CD4 and CD8 memory T cells with a concomitant decrease in frequency of naïve T cells compared to non-ATG induction. In adjusted and unadjusted models, ATG induction was associated with increased early event-free survival, with no difference in long-term patient or allograft survival. Decreased CD4+ naïve and increased CD4+ effector memory T cell frequencies were associated with improved clinical outcomes. Though immunologic parameters are drastically altered with ATG induction, long-term clinical benefits remain unclear in pediatric patients.

Original languageEnglish
Pages (from-to)766-775
Number of pages10
JournalAmerican Journal of Transplantation
Issue number2
StatePublished - Feb 2021
Externally publishedYes


  • clinical research/practice
  • immune regulation
  • immunosuppressant - polyclonal preparations: rabbit antithymocyte globulin
  • immunosuppression/immune modulation
  • kidney transplantation/nephrology
  • pediatrics
  • translational research/science


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