[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Other immunomodulating biologics](https://durgical.com/en/pharmacology/classes/other-immunomodulating-biologics/) › Anti-thymocyte globulin

# 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.

Updated Nov 1, 2026

Also called: antithymocyte immunoglobulin (rabbit), antilymphocyte immunoglobulin (horse), lymphocyte immune globulin, ATG

## Quick facts

**Group**
[Other immunomodulating biologics](https://durgical.com/en/pharmacology/classes/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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## 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 →](https://durgical.com/en/conditions/kidney-transplant-rejection/)
- Induction in kidney transplant with delayed graft function, sparing early calcineurin inhibitors
- Aplastic anaemia (horse product) [Aplastic anaemia →](https://durgical.com/en/conditions/aplastic-anaemia/)

## Adverse effects

### Common

- Fever and chills
- Nausea, vomiting, diarrhoea
- Swelling of hands and feet, tiredness
- Headache, muscle and joint pain

### Serious (rare, important)

- Infusion reactions within the first day: fever, chills, low blood pressure, breathing difficulty; rarely anaphylaxis
- Serum sickness and glomerulonephritis
- Low white cell and platelet counts
- Serious infections, lymphoma and skin cancer

## 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

## Memory aid

ATG = All T cells Gone: fever and chills first, low counts next, serum sickness last.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/anti-thymocyte-globulin/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Basiliximab](https://durgical.com/en/pharmacology/basiliximab/)
- [Belatacept](https://durgical.com/en/pharmacology/belatacept/)
- [Tacrolimus](https://durgical.com/en/pharmacology/tacrolimus/)

## Related conditions 2

- [Kidney transplant rejection](https://durgical.com/en/conditions/kidney-transplant-rejection/)
- [Aplastic anaemia](https://durgical.com/en/conditions/aplastic-anaemia/)

[← Back to the class: Other immunomodulating biologics](https://durgical.com/en/pharmacology/classes/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](https://www.medlineplus.gov/druginfo/meds/a626020.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Anti-thymocyte Globulin (Equine) Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a625031.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L04AA04) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/anti-thymocyte-globulin/