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Antithymocyte globulin in cadaver renal grafts: prophylaxis and antirejection therapy with three different
Abstract:
Three different preparations of antithymocyte globulin were used to treat recipients of cadaver kidney transplants. Twenty patients received Connaught Institute/Armand-Frappier ATG prophylactically beginning on the day of grafting and achieved superior graft and patient survival compared to 18 concurrent controls. Pressimmune as a 5-day course was able to reverse steroid resistant rejections in 20 of 31 recipients as was ATGAM in three of six treated patients receiving it for 10 days. These short courses were associated with a 16% early and a 10% late relapse rate. The combination of high steroid therapy, maintenance azathioprine and ATG was associated with an infection rate of 22%.
Insights
Antithymocyte globulin (ATG) improved survival in kidney transplant patients. Different ATG preparations effectively treated rejections, though short courses had some relapse risk.
Area of Science:
- Immunology
- Nephrology
- Transplantation
Background:
- Antithymocyte globulin (ATG) is used in organ transplantation to prevent or treat rejection.
- Optimizing ATG use in kidney transplantation requires understanding the efficacy of different preparations and treatment protocols.
Purpose of the Study:
- To evaluate the effectiveness of three different antithymocyte globulin preparations in cadaver kidney transplant recipients.
- To compare prophylactic ATG use with its use in treating steroid-resistant rejections.
Main Methods:
- Prospective evaluation of three ATG preparations: Connaught Institute/Armand-Frappier ATG (prophylactic), Pressimmune (5-day course), and ATGAM (10-day course).
- Comparison of graft and patient survival rates between ATG-treated groups and concurrent controls.
- Assessment of relapse rates and infection rates in patients receiving ATG.
Main Results:
- Prophylactic Connaught Institute/Armand-Frappier ATG significantly improved graft and patient survival compared to controls.
- Pressimmune and ATGAM successfully reversed steroid-resistant rejections in a majority of treated patients.
- Short ATG courses were associated with a 16% early and 10% late relapse rate.
- Combined immunosuppression including ATG, high-dose steroids, and azathioprine resulted in a 22% infection rate.
Conclusions:
- Antithymocyte globulin is a valuable therapeutic agent in kidney transplantation, offering benefits in both prophylaxis and treatment of rejection.
- Careful consideration of ATG preparation, dosage, and duration is necessary to balance efficacy with risks like relapse and infection.
- Further research into optimizing immunosuppressive strategies in kidney transplantation is warranted.