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. 1968 May;126(5):1023-35.

Heterologous antilymphocyte glubulin, histoincompatiblity matching, and human renal homotransplantation

T E Starzl, C G Groth, P I Terasaki, C W Putnam, L Brettschneider, T L Marchioro

Heterologous antilymphocyte glubulin, histoincompatiblity matching, and human renal homotransplantation

T E Starzl et al. Surg Gynecol Obstet. 1968 May.
No abstract available

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Figures

Fig. 1
Fig. 1
The course of a patient who received antilymphocyte globulin (ALG) before and for the first 4 months after renal homotransplantation. The donor was an older brother. The Terasaki match was grade A. There was no early rejection. Prednisone therapy was started 40 days postoperatively because of the high rises in the serologic titers which warned against a possible anaphylactic reaction. Note the insidious onset of late rejection after cessation of globulin therapy. This was treated by increasing the maintenance dose of steroids. This delayed complication occurred in only 2 of the original 20 patients.
Fig. 2
Fig. 2
Survival curve of the first 20 patients treated with antilymphocyte globulin (ALG) compared to that in 3 previous series of consanguineous transplantations at our institutions. Follow-up periods for the globulin-treated group were 10 to 16 months. The numbers in the upper curve indicate the patients at risk for each monthly interval.
Fig. 3
Fig. 3
The average azathioprine and prednisone doses per kilogram per day and the creatinine clearances for the first 16 postoperative weeks, shaded area, and for the subsequent 6 months, solid area. Shown are the retrospective control series 1, 2, and 3, and the antilymphocyte globulin (ALG) series, group 4. Inclusion in the analysis was contingent upon survival for 294 days, a condition which was met with the highest regularity in the patients in the ALG group.
Fig. 4
Fig. 4
Average creatinine clearances and daily prednisone doses for the 19 of 20 globulin-treated patients who lived for at least 10 months after receipt of homografts from blood relatives. These results are compared with pooled data from the 50 of 71 patients previously observed who had lived for this long after similar intrafamilial homotransplantation. Note the superior function and the smaller steroid doses of the globulin-treated patients who, because of their greater incidence of survival, were a less highly selected group than the included recipients in the retrospective control series.
Fig. 5
Fig. 5
The average daily prednisone doses and creatinine clearances per week for the first 9 weeks after transplantation are shown for the 38 globulin-treated patients, grouped according to the histocompatibility with their donors. The A, B, and C rating indicates progressively less favorable antigenic matches. There was a positive correlation between the quality of the match and the level of the creatinine clearances as well as an inverse correlation between the excellence of the match and the average doses of prednisone.
Fig. 6
Fig. 6
Course of a 20 year old woman who received a course of heterologous globulin therapy beginning 5 months after transplantation of a homograft from her mother. Previously, reductions in prednisone dosage led to slow rejection. As she was treated with antilymphocyte globulin, prednisone was reduced to 15 milligrams per day without incident. During the year since the completion of globulin therapy, her function has remained relatively stable at a prednisone dose of 15 milligrams per day. Her antigenic match with her donor was grade B. In this instance, the multiple early postoperative complications made any hope for survival dependent upon rapid reduction of the steroid quantities.
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References

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