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Graphic with the text 'Kidney Transplant Acute Rejection' with kidney icon on a blue background with kidney line patterns behind a woman, and a small disclaimer 'Not an actual patient'.

Both Recipient and Donor Risk Factors should be Considered when Evaluating Risk of Acute Rejection1,2

Many Factors Are Associated With an Increased Risk of Acute Rejection1-7

Graphic showing donor and recipient risk factors for acute rejection arranged around a central fingerprint design. Donor risk factors include blood group incompatibility, cold ischemia time (CIT) greater than 24 hours, high KDPI, living unrelated donor (LURD), and delayed graft function (DGF). Recipient risk factors include younger recipient or older donor age, Black race, presence of DSA, cPRA greater than 0%, and HLA sensitization. Text below reads ‘Acute rejection may happen at ANY level of risk8.

Patients with 1 or more risk factors may be considered to be at high risk of acute rejection1

Protection against Acute Rejection is a Critical Step to Preserve Kidney Function9

Graphic showing a pie chart with dark and light blue people icons illustrating proportions, alongside the text ‘62% of patients who experienced acute rejection in the first 3 months did not return to normal kidney function9*†,’ with footnotes stating ‘*A retrospective analysis from 28,867 kidney transplant recipients receiving a deceased donor graft between 1995 and 2005.9' and '†Return to normal was defined as SCr restored to <130 μmol/L.9'

Potential Consequences of Acute Rejection to the Patient and Transplant Center

Icon of a person shown as a simple dark blue silhouette.

Patient

  • Reduced quality of life and increased emotional burden10,11
  • Return to long-term dialysis10,12,13
  • Retransplantation10
  • Increased costs10
Icon of a hospital building shown as a dark blue silhouette.

Transplant Center

  • Increased likelihood of regulatory scrutiny14
  • Increased costs/resources associated with13,15
    • Treatment of acute rejection
    • Additional biopsies
    • Hospitalization (return to dialysis)
    • Graft failure

What impact does acute rejection have at your center?

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Important Safety Information

WARNING: IMMUNOSUPPRESSION. Thymoglobulin should only be used by physicians experienced in immunosuppressive therapy in transplantation.
  • Contraindications. Thymoglobulin is contraindicated in patients with a history of allergy or anaphylaxis to rabbit proteins or to any product excipients, or who have active acute or chronic infections which contraindicate any additional immunosuppression.
  • Management of Immunosuppression. To prevent over-immunosuppression, physicians may wish to decrease the dose of the maintenance immunosuppression regimen during the period of Thymoglobulin use. Dosing for Thymoglobulin is different from dosing for other ATG products, because protein composition and concentrations vary depending on the source of ATG. Thymoglobulin should be used under strict medical supervision in a hospital setting, and patients should be carefully monitored during the infusion.
  • Immune Mediated Reactions. Serious immune-mediated reactions, including anaphylaxis or severe cytokine release syndrome (CRS), have been reported with the use of Thymoglobulin. Fatal anaphylaxis has been reported. If an anaphylactic reaction occurs, the infusion should be terminated immediately.
  • Infusion-Associated Reactions. Cases consistent with cytokine release syndrome (CRS) have been reported with rapid infusion rates. CRS is attributed to the release of cytokines by activated monocytes and lymphocytes. Severe acute CRS can cause serious cardiorespiratory events and/or death. Close compliance with the recommended dosage and infusion time may reduce the incidence and severity of infusion-associated reactions (IARs). Slowing the infusion rate may minimize many of these IARs. Reactions at the infusion site may include pain, swelling, and redness of the skin.
  • Hematologic Effects. Low counts of platelets and white blood cells (including low counts of lymphocytes and neutrophils) have been identified and are reversible following dose adjustments. Total white blood cell and platelet counts should be monitored.
  • Infection and Malignancy. Infections, reactivation of infection, febrile neutropenia, sepsis, malignancies including lymphoproliferative disorders (LPD) and other lymphomas as well as solid tumors have been reported after Thymoglobulin administration in combination with multiple immunosuppressive agents. These events can be fatal.
  • Immunization. The safety of immunization with attenuated live vaccines following Thymoglobulin therapy has not been studied; therefore, immunization with attenuated live vaccines is not recommended for patients who have recently received Thymoglobulin.
  • Overdosage. Thymoglobulin overdosage may result in leukopenia (including lymphopenia and neutropenia) and/ or thrombocytopenia, which can be managed with dose reduction.
  • Adverse Reactions. The most common adverse reactions and laboratory abnormalities (incidence >5% higher than comparator) are urinary tract infection, abdominal pain, hypertension, nausea, shortness of breath, fever, headache, anxiety, chills, increased potassium levels in the blood, and low counts of platelets and white blood cells.
  • During post-marketing surveillance, arthralgia/myalgia, lymphadenopathy, proteinuria, and decreased oxygen saturation tend to occur 5 to 15 days after Thymoglobulin infusion and are consistent with serum sickness. Symptoms are manageable with corticosteroid treatment.

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Important Safety Information

Abbreviations: CIT, cold ischemia time; cPRA, calculated panel reactive antibodies; DGF, delayed graft function; DSA, donor-specific antibodies; HLA, human leukocyte antigen; KDPI, Kidney Donor Profile Index; LURD, living unrelated donor; SCr, serum creatinine.

References:

1. Lebranchu Y, Baan C, Biancone L, et al. Pretransplant identification of acute rejection risk following kidney transplantation. Transplant Int. 2013;27(2):129-138.
2. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Working Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplantation. 2009;9(suppl 3):S1-S155.
3. Treat E, Chow EKH, Peipert JD, et al. Shipping living donor kidneys and transplant recipient outcomes. Am J Transplantation. 2018;18(3):632-641.
4. Øien CM, Reisæter AV, Leivestad T, Dekker FW, Line PD, Os I.Living donor kidney transplantation: the effects of donor age and gender on short- and long-term outcomes. Transplantation. 2007;83(5):600-606.
5. Jackson KR, Holscher C, Motter JD, et al. Posttransplant outcomes for cPRA-100% recipients under the new kidney allocation system. Transplantation. 2020;104(7):1456-1461.
6. Ravindra KV, Sanoff S, Vikraman D, et al. Lymphocyte depletion and risk of acute rejection in renal transplant recipients at increased risk for delayed graft function. Am J Transplantation. 2019;19(3):781-789.
7. Fuller TF, Feng S, Brennan TV, Tomlanovich S, Bostrom A, Freise CE. Increased rejection in living unrelated versus living related kidney transplants does not affect short term function and survival. Transplantation. 2004;78(7):1030-1035.
8. National Kidney Foundation. Kidney transplant: what you need to know. Accessed January 7, 2026. https://www.kidney.org/sites/default/files/kidneytransplant_updated.pdf
9. Opelz G, Döhler B; Collaborative Transplant Study Report. Influence of time of rejection on long-term graft survival in renal transplantation. Transplantation. 2008;85(5):661-666.
10. Ndemera H, Bhengu B. Factors contributing to kidney allograft loss and associated consequences among post kidney transplantation patients. Health Sci J. 2017;11(3):504.
11. Ouellette A, Achille MA, Vachon M. Psychological impact of kidney graft failure and implications for the psychological evaluation of retransplant candidates. Dial Transplantation. 2006;35(6):354-361.
12. Koo EH, Jang HR, Lee JE, et al. The impact of early and late acute rejection on graft survival in renal transplantation. Kidney Res Clin Pract. 2015;34(3):160-164.
13. Schnitzler MA, Johnston K, Axelrod D, Gheorghian A, Lentine KL. Associations of renal function at 1-year after kidney transplantation with subsequent return to dialysis, mortality, and healthcare costs. Transplantation. 2011;91(12):1347-1356.
14. Snyder JJ, Salkowski N, Wey A, et al. Effects of high-risk kidneys on scientific registry of transplant recipients program quality reports. Am J Transplantation. 2016;16(9):2646-2653
15. Łabus A, Mucha K, Kulesza A, Fliszkiewicz M, Paczek L, Niemczyk M. Costs of treatment of acute antibody-mediated rejection in kidney transplant recipients. Transplantation Proc. 2022;54(4):968-971.

Thymoglobulin and Sanofi are registered trademarks of Sanofi or an affiliate. MAT-US-2600051-v1.0-03/2026

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