Anti-Thymocyte Globulin (ATG)





  • Agents
    • Rabbit-Derived Ab (rATG, Thymoglobulin from Genzyme)
    • Horse-Derived Ab (eATG, Atgam from Pfizer)
  • Mechanism
    • Antibodies Directed Against T and B-Cell Receptors (Including Human Leukocyte Antigens, HLA): antibodies against CD45 (which plays a role in T-cell activaton) may be particularly important for reversing organ rejection and inducing tolerance
      • Complement-Dependent Opsonization -> T and B-lymphocyte depletion
      • Cytokine Release


  • xxx


  • IV:

Dose Adjustment

  • Hepatic
  • Renal

Adverse Effects

Hematologic Adverse Effects

  • Leukopenia (see Leukopenia, [[Leukopenia]])
  • Serum Sickness (see Serum Sickness, [[Serum Sickness]])
    • Epidemiology
      • May occur with subsequent exposure
      • More common with ATGAM
  • Thrombocytopenia (see Thrombocytopenia, [[Thrombocytopenia]])

Pulmonary Adverse Effects

Other Adverse Effects

  • Anaphylaxis (see Anaphylaxis, [[Anaphylaxis]])
  • Increased Risk of Malignancy
  • Increased Risk of Infection


  • Acute lung injury during antithymocyte globulin therapy for aplastic anemia. Can Respir J. 2009 Mar-Apr;16(2):e3-5 [MEDLINE]
  • Antithymocyte-associated reticulonodular pneumonitis during a conditioning regimen of reduced intensity for genoidentical bone marrow transplantation. April (2) 2001, Volume 27, Number 8, Pages 891-892 [MEDLINE]
  • Antithymocyte globulin for acute-graft-versus-host-disease prophylaxis in patients undergoing allogeneic hematopoietic cell transplantation: a systematic review. Leukemia. 2012 Apr;26(4):582-8 [MEDLINE]