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FAQs in Kidney Transplant

What is Thymogam?

Thymogam is a biological product. It is a sterile solution of Polyclonal antibodies primarily containing IgG type of antibodies, it is obtained from Horses hyperimmunized with Human Thymocytes. Hence it is called Antithymocyte Globuline (ATG)

It is used in patients as Induction therapy to prevent rejection in Kidney transplant patients at a dose of 25 mg/kg/day intravenously over a period of 4-5 hrs, one day before transplant. Patient will be required to hospitalize one day before transplant to receive Thymogam.

It is also used in patients to treat acute rejection; it is given at dose of 10-20 mg/kg/day intravenously for 14 days followed by alternate day dosing for 14 days over a period of 4-5 hours. Hence Patient will receive Thymogam for total 21 days. Patient need hospitalization for all days while receiving Thymogam.

Who is a candidate for a kidney transplant?

Any patient whose kidneys have permanently stopped working is a potential candidate for a kidney transplant. However, many factors must be considered in choosing between transplantation and chronic dialysis for a given individual. Among these factors are age, other medical problems, and personal considerations of work and lifestyle. You should discuss the options with your doctor and attempt to obtain as much information as possible in reaching your decision.

What is rejection?

The body has a normal defense mechanism, called the immune system, which protects it from foreign substances, such as bacteria and viruses. The body sees a kidney transplant as foreign and attacks it to get rid of it. This process is called rejection, and is a normal response of the body's immune system. Even though rejection may be prevented by medication, the possibility of rejection never goes away. The body will not adapt to the kidney, nor will the kidney change to accommodate the body, although after the first 3 – 6 months, rejection is less of a problem.

How is rejection prevented?

To prevent rejection patients are given drugs, called immunosuppressive medications. These drugs work by lowering the body's immune response, making it incapable of destroying the kidney. There are now several immunosuppressive medications available, giving transplant physicians new flexibility in treating recipients. Most patients will receive a combination of drugs.

How is Thymogam thought to work in prevention of rejection?

Thymogam is an Immunosuppressant drug (it will suppress immunity). Healthy body's immune system is designed to keep healthy by sensing "foreign invaders," such as bacteria, and rejecting them but immune system will also sense that transplanted kidney is foreign. To prevent patient's body from rejecting it, kidney transplanted patients are prescribed with Thymogam which suppresses immunity.

How is Thymogam thought to work in treatment of acute rejection?

The goal of treatment in acute rejection is to make sure the transplanted organ or tissue works properly and to suppress patient's immune system response. Suppressing the immune response can prevent transplant rejection.

How many vials of Thymogam do I need if I am prescribed with dose of 25 mg/kg/day?

Thymogam is given at a dose of 25 mg/kg/day as single bolus dose. Hence, total required dose varies with the patient's body weight.

e.g. If your weight is 50 Kg then your dose will be 1250 mg/day. Thymogam is available at strength of 250 mg, hence you will require 5 vials of Thymogam 250 mg.

For more information, see section Dose Calculator

What are the serious adverse reactions associated with Thymogam?

Frequently reported adverse reactions among patients enrolled in aplastic anaemia studies were

  1. Fever, chills, skin rashes, arthralgia and thrombocytopenia.
  2. Abnormal tests of liver function (SGOT, SGPT, alkaline phosphatase) and renal function (serum creatinine)
  3. Serum sickness: this happens when immune system reacts to foreign proteins in the medicine. It causes fever, rash, joint pain, and muscle aches
  4. Less frequently reported reactions: Headache, nausea, vomiting, diarrhoea, dyspnoea, hypotension, night sweats, stomatitis, chest pain, back pain, pain at the infusion site and peripheral thrombophlebitis.
  5. Rarely reported reactions: periorbital oedema, agitation, dizziness, weakness or faintness, malaise, epigastric pain or hiccoughs, laryngospasm, paraesthesia, lymphadenopathy, infection, possible encephalitis, herpes simplex reactivation, wound dehiscence, hyperglycaemia, hypertension, oedema, pulmonary oedema, pleural effusions, tachycardia, seizure, anaphylaxis, iliac vein obstruction, renal artery thrombosis, proteinuria and toxic epidermal necrosis.

What are the most common side effects I may experience with Thymogam?

  1. Fever
  2. Chills
  3. Urticaria (Skin rash)

These side effects may go away after treatment with Thymogam.

How do I know if I am allergic to Thymogam?

Physicians can recommend skin testing before commencing treatment with Thymogam.

  1. A conservative, conventional approach would first employ epicutaneous (prick) testing with undiluted Thymogam. If the patient does not show a wheal ten minutes after pricking, then proceed to step 2.
  2. Intradermal testing with 0.02mL of a 1:1000 dilution of Thymogam in Sodium chloride injection with a separate Sodium chloride injection control of similar volume. Observe the results every 10 minutes over the first hour after intradermal injection. A wheal of 3mm or greater in diameter at the site of Thymogam injection than that at the Sodium chloride injection control site (or a positive prick test) shows clinical sensitivity and an increased possibility of systemic allergic reactions.

Note :

The predictive value of this test has not been proved clinically. Allergic reactions such as anaphylaxis have occurred in patients whose skin test is negative.

When shall I call doctor while receiving Thymogam infusion?

You should call your doctor if you experience Severe anaphylactic reaction (hyper allergic reaction), susceptibility to get allergic reaction can be predicted with Skin test as mentioned above.

Your doctor/nurse should also watch out for Thrombocytopenia (Fall in platelet count)/Leucopenia (Fall in WBC count) after infusion.

What can I do if I experience fall in blood count when taking Thymogam?

You should call doctor for consultation. You may receive Blood transfusion after consulting with doctor.

Where can I get Thymogam?

You can get Thymogam injection from the Hospital Pharmacies. It is available at all major hospital pharmacies which are supplied through authorized distributors for Bharat Serums and Vaccines Limited.

For more information regarding availability, please see our section Contact Us.

Are there any clinical trial available for patients with Kidney transplant?

There are trials conducted for Thymogam at single center (Single hospital) and muticenter (Multiple hospital) on patients with Aplastic Anemia in India.

What should I do if I am taking Thymogam or am prescribed other medicines or supplements while taking Thymogam?

It is important to tell your doctor about all medicines or herbal/ayurvedic/unani medicines that you are taking.

Do not start taking any new medicines or herbal/ayurvedic/unani medicines before talking with your doctor.