Table 3: Overview of the Infectious Complications of Anti-Thymocyte Globulin (ATG)

  Risk Impact on Prophylaxis Impact on Laboratory Monitoring
Bacterial Infections Unclear impact None Aggressive microbiologic evaluation for febrile transplant recipients who have received ATG
BK Virus   Increased risk of infection especially with higher doses of ATG administration (54) N/A Consider more frequent screening (monthly rather than quarterly)
CMV   Increased risk of infection (9) Consider extended prophylaxis to 6 months, especially in D+/R- If preemptive protocol followed, consider extended duration of monitoring
EBV / PTLD   Possible increased risk, especially EBV D+/R-, though data is mixed (64) None Active screening for EBV viremia if EBV D+/R-
Fungal Infections No increased risk during induction; Increased risk during rejection therapy If exposure to endemic fungi, prophylaxis for 6-12 months is indicated If exposure to endemic fungus, routine screening likely indicated
HCV/HBV   Accelerated HCV replication but no increased rate of hepatic graft injury (24)


No association with poor outcomes with HCV + renal transplant pts.
N/A for HCV, Follow standard protocols for HBV prophylaxis Consider routine viral load monitoring in known to have positive viremia. 


Consider monitoring for reactivation of viremia in recipients with negative viral loads prior to transplant
HSV/HZV Increased Adequately covered by CMV prophylaxis or acyclovir derivatives if not on CMV prophylaxis None
Pneumocystis Increased risk of infection without appropriate prophylaxis (29) Minimum of 6-12 months of prophylaxis, consider prolonged prophylaxis in heart and/or lung recipients None