Drugs may be given during the peri-transplant period to prevent transplant-related complications or facilitate engraftment.

Question 86: ALG, ALS, ATG, ATS

Anti-Lymphocyte Globulin (ALT), Anti-Lymphocyte Serum (ALS), Anti-Thymocyte Globulin (ATG), or Anti-Thymocyte Serum (ATS) are serum or gamma globulin preparations containing polyclonal immunoglobulins directed against lymphocytes. These drugs are usually prepared from animals immunized again human lymphocytes. Indicate “yes” or “no” if ALG, ALS, ATG, or ATS was administered during the peri-transplant period. If “yes,” continue with question 87. If “no,” continue with question 94.

Question 87: Total dose

Report the total dose actually given. Do not report the prescribed dose or the daily dose. The pharmacy record or Medication Administration Record (MAR) should be used for determining the exact total dose given.

Question 88-89: Absolute lymphocyte count (prior to first dose)

Indicate if the absolute lymphocyte count is “known” or “unknown” prior to the first administration dose of ALG, ALS, ATG, or ATS. If “known” report the absolute lymphocyte count and specify the units of measurement in question 89. If “unknown,” continue with question 90.

Question 90-91: Date first dose

Indicate if the date when the first dose of ALG, ALS, ATS, or ATS was administered is “known” or “unknown.” If “known,” report the date when the first dose was administered in question 91. If “unknown,” continue with question 92.

Question 92-93: Date last dose

Indicate if the date when the last dose of ALG, ALS, ATS, or ATS was administered is “known” or “unknown.” If “known,” report the date when the last dose was administered in question 93. If “unknown,” continue with question 94.

Question 94: Alemtuzumab (Campath)

Antibody preparations that are infused in the recipient. Indicate “yes” or “no” if alemtuzumab was administered during the peri-transplant period. If “yes,” continue with question 95. If “no,” continue with question 100.

Question 95: Total dose

Report the total dose actually given. Do not report the prescribed dose or the daily dose. The pharmacy record or Medication Administration Record (MAR) should be used for determining the exact total dose given.

Question 96-97: Date first dose

Indicate if the date when the first dose of alemtuzumab administered is “known” or “unknown.” If “known,” report the date when the first dose was administered in question 97. If “unknown,” continue with question 98.

Question 98-99: Date last dose

Indicate if the date when the last dose of alemtuzumab was administered is “known” or “unknown.” If “known,” report the date when the last dose was administered in question 99. If “unknown,” continue with question 100.

Question 100: Were clinically significant donor specific anti-HLA antibodies detected?

Indicate if clinically significant donor specific anti-HLA antibodies were detected. If “yes,” continue with question 101. If “no,” continue with question 104.

If testing for clinically significant donor specific anti-HLA antibodies was not performed, select “not done” and continue with question 104.

Questions 101-103: Was the recipient on a desensitization protocol?

Indicate “yes” or “no” if the recipient was on a desensitization protocol. If “yes,” check the method(s) of desensitization is question 102. If “other method” is selected, specify in question 103. If “no,” continue with question 104.

Section Updates:

Question Number Date of Change Add/Remove/Modify Description Reasoning (If applicable)
. . . . .
Last modified: Dec 22, 2020

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