*PURPOSE: Antithymocyte globulin rabbit (ATG) is one of the main induction agents and treatments for cellular rejection in solid organ transplantation. Dosing is complicated by varying practices in use of actual, ideal, or adjusted body weight, the need to reduce or hold dose for toxicities, and compounding considerations based on vascular access. This project aimed to investigate the incidence of ATG medication waste, analyze the root cause, and propose cost-saving initiatives. *METHODS: This retrospective review included all ATG dispenses for solid organ transplant spanning Jul 2021-Jun 2022 at a large transplant center. The primary objective was to evaluate the incidence of medication waste and associated cost due to inappropriate dosing or ordering of ATG. Secondary objectives included incidence of medication waste stratified by organ and reasons of medication waste (Figure 1). *RESULTS: A total of 459 dispensed bags of ATG were identified, of which, 24 bags did not have a corresponding administration. The incidence of ATG waste was 5.2%, equivalent to a loss of 102 ATG vials and associated cost of approximately US$120,000. Of the wasted doses, 14 (58%) were for induction indication and 10 (42%) were for treatment of rejection. Waste most often occurred in kidney and/or pancreas transplant (14, 58%), followed by lung transplant (Table 1). The most common cause for waste was the decision to hold a dose due to thrombocytopenia or leukopenia after the dose was compounded (9, 38%) (Table 2). Incorrect vascular access and decision to hold dose were more common in kidney/pancreas transplants. Only one dose was wasted in liver transplant which was due to incorrect vascular access (Figure 2). *CONCLUSIONS: Proposed cost-saving initiatives include evaluating indication, laboratory values, accurate vascular line access, and confirming the dose by pharmacist with the transplant service prior to compounding each ATG dose. Electronic learning modules will be provided to transplant personnel and pharmacy department. After implementation, we aim to reduce medication waste to less than 2% annually. Labor cost will be evaluated as counterbalance associated with workflow changes. [

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]CITATION INFORMATION: Postell A., Soto-Arenall M., Tran Y. Cost-Saving Initiatives for Antithymocyte Globulin (Rabbit) at a Large Transplant Center AJT, Volume 23, Issue 6, Supplement 1.

Ashley Postell Pharm.D., BCPS

Mayo Clinic in Florida

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