Monoclonal and polyclonal antibodies: clinical aspects

Over the years, the ways in which the antibodies ATG and OKT3 have been used in clinical transplantation have changed. ATG was first on the scene and has been used as initial immune suppression in certain forms of transplantation, of which cardiac transplantation is one good example. It has not been commonly used in renal transplantation, but there is evidence that this may be changing. The nephrotoxic side-effects of cyclosporin continue to cause anxiety, and high rates of initial non-function of kidney allografts have made early management difficult; this may have contributed to some early graft failures. There is currently interest in avoiding the use of cyclosporin initially by commencing immune suppression treatment with ATG, in an attempt to improve the immediate function rate of kidney grafts. When function is established, more conventional treatment schedules, usually with cyclosporin A, are introduced. ATG is also being incorporated in basic immunesuppressive regimes as part of multiple drug treatments. The hypothesis of multiple drug treatments is based on the idea that if a number of different immune suppressive agents are used, then the dose of each may be reduced, with minimisation of side-effects. This concept may be true, but the price may be that of an increased rate of malignancy in the long-term graft recipients.(ABSTRACT TRUNCATED AT 250 WORDS)