Healthy kidney glowing amidst medical symbols, representing successful transplant outcomes.

r-ATG vs. ATG-F: Which Immunosuppressant Offers Better Outcomes for Kidney Transplant Patients?

Soraya Malik in Health & Wellness August 2025 • 4 min read.

"A recent study from China highlights the cost-effectiveness and efficacy of r-ATG over ATG-F in kidney transplant induction therapy."

Kidney transplantation offers a lifeline for individuals grappling with end-stage renal disease, significantly enhancing their quality of life and overall survival rates. However, the journey to a successful transplant is fraught with challenges, with the choice of induction therapy playing a pivotal role. Induction therapy, administered at the time of transplant, aims to prevent acute rejection—a major cause of early graft loss. Among the commonly used induction agents are rabbit antithymocyte globulin (r-ATG) and ATG-Fresenius (ATG-F).

A groundbreaking study conducted in China has shed light on the comparative effectiveness and cost-efficiency of r-ATG versus ATG-F in patients undergoing kidney transplantation from donation after cardiac death (DCD). The research, spotlighting the nuances of immunosuppressant choices, brings crucial insights for healthcare providers and patients alike.

This article delves into the findings of this pivotal study, exploring why r-ATG is emerging as the preferred option for kidney transplant induction therapy. By unpacking the key factors driving this trend, we aim to provide a comprehensive understanding of the clinical and economic implications for patients navigating the complexities of kidney transplantation.

r-ATG: The Superior Choice for Kidney Transplant Induction?

Healthy kidney glowing amidst medical symbols, representing successful transplant outcomes.

The Chinese study meticulously compared r-ATG and ATG-F using sophisticated models that simulated both 1-year and 5-year time horizons. These models were designed to evaluate the cost-effectiveness of each therapy by incorporating a range of critical factors, including the costs associated with drug acquisition, maintenance treatments, and management of complications such as acute rejection (AR), delayed graft function (DGF), and chronic dysfunction.

The results of the study underscored the superiority of r-ATG over ATG-F. Specifically, the 1-year model revealed that patients treated with r-ATG experienced slightly more discounted total Quality-Adjusted Life Years (QALYs) compared to those treated with ATG-F (0.6925 vs. 0.6825). More impressively, this benefit was achieved at a lower discounted total cost (RMB102,103 vs. RMB107,526).

QALYs Defined: QALYs, or Quality-Adjusted Life Years, provide a standardized way to measure the benefit of medical interventions. One QALY represents one year in perfect health, allowing healthcare professionals to assess the value and impact of different treatments.
Cost-Effectiveness Thresholds: Determining whether a treatment is cost-effective often involves comparing its cost per QALY gained against a predetermined threshold. Different countries and healthcare systems may have varying thresholds based on their economic conditions and healthcare priorities. Treatments that fall below the threshold are generally considered cost-effective.

Extending the evaluation period to a 5-year horizon further solidified the advantages of r-ATG. The 5-year model demonstrated that r-ATG continued to offer more QALYs (2.8982 vs. 2.8486) at a reduced cost (RMB270,709 vs. RMB277,751). These findings highlight the long-term benefits of r-ATG, suggesting that it not only improves the immediate outcomes for kidney transplant recipients but also provides sustained health and economic advantages over time.

The Future of Immunosuppression: Tailoring Therapies for Optimal Outcomes

The findings of the Chinese study carry significant implications for clinical practice. As the researchers emphasized, r-ATG "should be considered as a better choice than ATG-F for induction therapy for Chinese patients undergoing kidney transplantation." This recommendation underscores the need for healthcare providers to carefully evaluate the available evidence and consider the specific needs of their patients when selecting induction therapies. By tailoring treatment approaches based on factors such as cost-effectiveness and long-term outcomes, clinicians can optimize the chances of successful transplantation and improve the overall well-being of their patients.

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Everything You Need To Know

In kidney transplantation, what is the purpose of induction therapy, and what are the common agents used for this purpose?

Induction therapy in kidney transplantation aims to prevent acute rejection, a major cause of early graft loss. The commonly used induction agents are rabbit antithymocyte globulin (r-ATG) and ATG-Fresenius (ATG-F). These therapies suppress the immune system to prevent it from attacking the new kidney. The choice between r-ATG and ATG-F can significantly impact the success of the transplant. While other immunosuppressants exist, these two are specifically highlighted in the context of a comparative study.

What were the primary findings of the Chinese study comparing r-ATG and ATG-F in kidney transplant patients, and how did the study measure the outcomes?

The Chinese study found that r-ATG was more cost-effective and resulted in slightly more Quality-Adjusted Life Years (QALYs) compared to ATG-F in kidney transplant patients. This was assessed using models simulating 1-year and 5-year time horizons, incorporating costs associated with drug acquisition, maintenance treatments, and management of complications like acute rejection (AR), delayed graft function (DGF), and chronic dysfunction. The study specifically evaluated kidney transplants from donation after cardiac death (DCD).

Can you elaborate on the concept of Quality-Adjusted Life Years (QALYs) and how they are used to determine the cost-effectiveness of treatments like r-ATG and ATG-F?

Quality-Adjusted Life Years (QALYs) provide a standardized way to measure the benefit of medical interventions. One QALY represents one year in perfect health. Healthcare professionals use QALYs to assess the value and impact of different treatments. In the study, r-ATG was found to offer more QALYs at a lower cost compared to ATG-F, indicating it provides better health outcomes per unit of cost. Cost-effectiveness thresholds, which vary by country and healthcare system, are used to determine if the cost per QALY gained is acceptable. Treatments falling below the threshold are generally considered cost-effective. Treatments that do not provide substantial increase in QALYs may not be considered cost-effective.

What are the long-term benefits of using r-ATG over ATG-F, as suggested by the 5-year model in the Chinese study?

The 5-year model in the Chinese study demonstrated that r-ATG continued to offer more QALYs at a reduced cost compared to ATG-F. This suggests that r-ATG not only improves immediate outcomes for kidney transplant recipients but also provides sustained health and economic advantages over time. The lower costs of r-ATG over the long term include reduced expenses associated with managing complications and the extended health benefits contribute to greater overall well-being. These advantages include reduced expenses related to complications and improved quality of life for patients.

What implications does the Chinese study have for clinical practice regarding the choice between r-ATG and ATG-F for kidney transplant induction therapy?

The study suggests that r-ATG should be considered a better choice than ATG-F for induction therapy for Chinese patients undergoing kidney transplantation. This underscores the need for healthcare providers to carefully evaluate the available evidence and consider the specific needs of their patients when selecting induction therapies. By tailoring treatment approaches based on factors such as cost-effectiveness and long-term outcomes, clinicians can optimize the chances of successful transplantation and improve the overall well-being of their patients. This recommendation emphasizes personalized medicine and evidence-based decision-making in transplant care.