Monoclonal and polyclonal antibodies: clinical aspects

Area of Science:

• Transplantation immunology
• Nephrology

Background:

• The use of antithymocyte globulin (ATG) and OKT3 in clinical transplantation has evolved.
• ATG has been historically used in cardiac transplantation but less so in renal transplantation.
• Concerns regarding cyclosporine's nephrotoxicity and high rates of early kidney allograft non-function necessitate alternative immunosuppressive strategies.

Purpose of the Study:

• To explore the changing role of ATG in clinical transplantation, particularly in renal transplantation.
• To investigate the potential of using ATG as an initial immunosuppressive agent to improve immediate kidney graft function.
• To examine the integration of ATG into multi-drug immunosuppressive regimens.

Main Methods:

• Review of clinical practices and evidence regarding ATG and OKT3 use in transplantation.
• Analysis of strategies to mitigate cyclosporine-induced nephrotoxicity.
• Exploration of multi-drug immunosuppression protocols.

Main Results:

• ATG is being considered for initial immunosuppression in renal transplantation to improve graft function.
• This approach may help avoid or delay the use of nephrotoxic cyclosporine.
• ATG is also incorporated into multi-drug regimens, aiming to reduce individual drug doses and side effects.

Conclusions:

• The use of ATG in renal transplantation is gaining traction as a strategy to enhance early graft function.
• Multi-drug immunosuppression including ATG may offer benefits but requires long-term monitoring for potential risks like malignancy.