Induction with Thymoglobin in high-risk renal transplant patients: beauty and the beast

Renal transplantation remains the treatment of choice in renal failure patients, one of the major challenges is to promote acceptance of the newly transplanted graft by the host immune system. Therefore, induction protocols were adopted to achieve this objective. The aim of induction immunosuppression is to reduce the risk of acute rejection and delayed graft function (DGF). The optimum induction protocol remains uncertain. However, induction regimens utilizing biological antibodies proved to be not only safe and effective, but also they allow better patient and graft survival. Biological antibodies can be categorized into depletive (e.g. Antithymocyte globulin (ATG) and Alemtuzumab) and non-depletive
antibodies (e.g. Basiliximab). Their use in the perioperative period has the advantage of lowering the doses of maintenance immune suppression, and even allows complete withdrawal or avoidance of some of these agents and their associated side effects. It also draws great attention in the promising strategies to induce tolerance of the host immune system to the transplanted graft,
which if therapeutically achieved, will be considered a revolutionary step in the transplantation immunology. The aim of our review is to focus on ATG, which is considered one of the effective induction agents, demonstrating its established
and potential uses in respect of induction immune suppression.