Administration of equine anti-thymocyte globulin via peripheral vein in renal transplant recipients

Background. Anti-thymocyte globulin (ATG) is used frequently as induction therapy in renal transplant recipients. It has been standard practice that the various polyclonal anti-lymphocyte preparations be administered via central line, vascular shunt, or arteriovenous fistula to avoid thrombophlebitis. Methods. We have safely administered equine ATG (Atgam) via peripheral veins since 1978. We now retrospectively review recent experience with 83 patients transplanted between 1993 and 1998 who received Atgam induction via peripheral vein. Heparin 1000 U and Solucortef 20 mg were added to the infusion. Acetaminophen and diphenhydramine were given before infusion. Results. Only two of 83 patients developed mild edema/erythema at or around the i.v. site. These reactions responded promptly to local management with warm soaks. No phlebitis or symptomatic venous thrombosis occurred in any patients. Conclusions. Equine ATG can be safely administered via peripheral vein infusion. Its use does not require continued hospitalization or placement of a central line. Peripheral vein infusion is safe, convenient, and economical.