{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:12:07Z","timestamp":1790079127070,"version":"4.0.1"},"reference-count":21,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Anti-T lymphocyte globulin (ATLG) is widely used as induction therapy in kidney transplantation; however, the clinical impact of the interval between individual ATLG doses remains poorly defined. We compared alternate-day and consecutive-day ATLG administration in first living-donor kidney transplant recipients at low immunological risk. Methods: This retrospective single-center cohort study included 195 first living-donor kidney transplant recipients who received ATLG induction therapy (alternate-day, n = 97; consecutive-day, n = 98). All recipients underwent their first kidney transplantation, received grafts from related living donors, were negative for donor-specific antibodies before transplantation, and received standardized maintenance immunosuppression. ATLG was initiated at approximately 2.0\u20132.5 mg\/kg per administration, with subsequent doses individualized according to peripheral CD3+ T-cell and lymphocyte counts. The primary outcome was the occurrence of at least one bacterial infection during the first post-transplant year. Secondary outcomes included biopsy-proven acute rejection, BK virus and cytomegalovirus (CMV) positivity, graft function, graft loss, and patient survival; rejection, graft loss, and mortality were recorded throughout the available follow-up. Multivariable logistic regression analysis was performed to identify independent predictors of bacterial infection. Results: Baseline recipient and donor characteristics were generally comparable between groups, although recipients receiving consecutive-day ATLG had higher rates of PRA class I and II positivity. Cumulative weight-adjusted ATLG exposure was comparable between the alternate-day and consecutive-day groups (7.4 [7.1\u20137.8] vs. 7.2 [5.4\u201310.2] mg\/kg, p = 0.207). The incidence of bacterial infection during the first post-transplant year was virtually identical in the alternate-day and consecutive-day groups (50.5% vs. 50.0%, p = 1.000). Likewise, no significant between-group differences were observed in biopsy-proven acute rejection (2.1% vs. 8.2%, p = 0.100), BK virus positivity (18.6% vs. 14.3%, p = 0.446), CMV positivity (17.5% vs. 12.2%, p = 0.321), graft loss (4.1% vs. 4.1%, p = 1.000), or all-cause mortality (7.2% vs. 4.1%, p = 0.372). In multivariable analysis, the ATLG administration schedule was not independently associated with bacterial infection (adjusted OR 1.21, 95% CI 0.64\u20132.30, p = 0.560). Recipient body mass index was the only independent predictor of bacterial infection (adjusted OR 1.08 per kg\/m2, 95% CI 1.00\u20131.15, p = 0.041). Conclusions: Among first living-donor kidney transplant recipients at low immunological risk, alternate-day ATLG administration was associated with a similar incidence of bacterial infection during the first post-transplant year. When cumulative weight-adjusted ATLG exposure was accounted for, the interval between individual doses was not independently associated with bacterial infection. Crude secondary-outcome comparisons should be interpreted cautiously because overall follow-up differed between groups. These findings support further prospective evaluation of flexible ATLG administration schedules in carefully selected kidney transplant recipients.<\/jats:p>","DOI":"10.3390\/jcm15197348","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7348","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Alternate-Day Versus Consecutive-Day Anti-T Lymphocyte Globulin Induction in First Living-Donor Kidney Transplant Recipients at Low Immunological Risk: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6565-8063","authenticated-orcid":false,"given":"Gulay","family":"Yilmaz","sequence":"first","affiliation":[{"name":"Department of Nephrology, Basaksehir Cam and Sakura City Research and Training Hospital, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebru","family":"Ozdemir","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center, Acibadem Atasehir Hospital, Istanbul 34642, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7156-8838","authenticated-orcid":false,"given":"Abdulhak Hamit","family":"Karayagiz","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Esenyurt Necmi Kadioglu State Hospital, Istanbul 34517, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Ibrahim","family":"Berber","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center, Acibadem University, Istanbul 34638, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Ulkem","family":"Cakir","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Acibadem University, Istanbul 34638, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1111\/j.1600-6143.2011.03686.x","article-title":"Systematic review: Kidney transplantation compared with dialysis in clinically relevant outcomes","volume":"11","author":"Tonelli","year":"2011","journal-title":"Am. 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