Anti-thymocyte globulin
Other immunomodulating biologics
Other immunomodulating biologics
Rabbit or horse antibodies against human T cells, infused in hospital to prevent or treat kidney transplant rejection, and (horse) for aplastic anaemia.
Also called: antithymocyte immunoglobulin (rabbit), antilymphocyte immunoglobulin (horse), lymphocyte immune globulin, ATG
Quick facts
- Group
- Other immunomodulating biologics
- Target
- Many T-lymphocyte surface proteins (CD2, CD3, CD4, CD8, CD25, HLA molecules and others)
- Used for
- Prevention and treatment · Aplastic anaemia
- Key effects
- Fever and chills · Nausea · Swelling of hands and feet
- Monitor
- Vital signs during the infusion · Signs of infection
- ATC
- L04AA04
No doses: the clinician sets them by the current guideline.
Mechanism of action
Anti-thymocyte globulin is a polyclonal mix of antibodies raised in rabbits or horses against human thymus cells. The antibodies coat many T-cell surface molecules, destroy circulating lymphocytes by complement- and cell-mediated killing, and block the function of the cells that remain, giving deep, lasting T-cell depletion.
- Polyclonal antibodies coat many T-cell surface proteins
- Complement and immune cells destroy the coated lymphocytes
- Remaining T cells function poorly
- Rejection is prevented or reversed
Indications
- Prevention and treatment of kidney transplant rejection Kidney transplant rejection →
- Induction in kidney transplant with delayed graft function, sparing early calcineurin inhibitors
- Aplastic anaemia (horse product) Aplastic anaemia →
Adverse effects
Common
- Fever and chills
- Nausea, vomiting, diarrhoea
- Swelling of hands and feet, tiredness
- Headache, muscle and joint pain
Contraindications
- Previous allergic reaction to the product (rabbit or horse proteins)
- Active serious infection
Key interactions
- Other immunosuppressants
- Deeper immunosuppression, with more infection and lymphoma risk.
- Vaccines, especially live vaccines
- Avoided during treatment unless the team agrees.
What is monitored
- Vital signs during the infusion and for the following day
- White cell and platelet counts
- Signs of infection
- Skin test for allergy before the horse product
Administration and safety
- Given only in hospital as a slow infusion into a large vein.
- Corticosteroid, paracetamol and an antihistamine are given before and during each infusion to reduce reactions.
- Rabbit and horse products are different medicines with different doses: the product name is checked carefully.
- If a reaction appears, the infusion is slowed or stopped and the team is called.
Pregnancy and breastfeeding
Pregnancy and breastfeeding are avoided: effective contraception is used during treatment and for some months afterward (the period depends on the product).
Nursing care
- Take vital signs before, during and after each infusion, and watch for reactions for the next day.
- Have anaphylaxis treatment ready at the bedside.
- Check blood counts before each dose and report bleeding or bruising.
- Teach to report fever, sore throat, cough or painful urination, and to use sun protection.
- Later rash, joint pain and fever may mean serum sickness: report them.
Pharmacokinetics
- Absorption
- Slow intravenous infusion over several hours in hospital
- Onset and duration
- Circulating T cells fall within the first days of treatment
Test yourself
Think of the answer, then tap the question to see it.
Is anti-thymocyte globulin monoclonal or polyclonal?
Polyclonal: a mixture of rabbit or horse antibodies against many T-cell surface proteins.
Which three medicines are given before the infusion to reduce reactions?
A corticosteroid, paracetamol (acetaminophen) and an antihistamine.
What late immune-complex reaction can follow anti-thymocyte globulin?
Serum sickness (rash, fever, joint pain), sometimes with glomerulonephritis.
Connections
← Back to the class: Other immunomodulating biologics
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Anti-thymocyte Globulin (Rabbit) Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Anti-thymocyte Globulin (Equine) Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.