Quadruple immunosuppression: comparison of OKT3 and Minnesota antilymphocyte globulin

From May 1977 to June 1988, 110 patients receiving cadaveric kidney transplants were selected to receive Orthoclone (OKT3; Ortho Pharmaceutical Corporation, Raritan, NJ; 5 mg intravenous bolus) (n = 43) or Minnesota antilymphocyte globulin (MAG; 20 mg/kg/day) (n = 67) as the induction phase of a quadruple immunosuppressive protocol. The duration of treatment ranged from 5 to 16 days for OKT3 (mean, 8 days) and 7 to 14 days for MAG (mean, 9 days) as dictated by the postoperative recovery of renal function. All patients were followed-up for at least 3 months (maximum, 18 months; mean, 10 months). Of the 43 patients receiving OKT3, 11 (26%) had rejection episodes that were reversed and did not reoccur. Two patients had episodes that could not be reversed, resulting in graft loss. Of the 67 patients receiving MAG, 38 (57%) experienced a first rejection episode within the follow-up period; 16 of these had repeat rejections. Renal function was significantly better in the OKT3 group. Although both OKT3 and MAG were associated with excellent patient (98%) and graft (92%) survival, OKT3 was easier to administer with fewer rejection episodes. It was concluded that OKT3 is superior to MAG as perioperative cytoreductive therapy following cadaveric kidney transplantation.