Reversal of acute renal allograft rejection with adjunctive AG therapy

Abstract

A randomized and controlled study was conducted to evaluate the efficacy of adjunctive antithymocyte globulin (ATG) therapy for the treatment of the initial rejection episode in first transplants of Haplo-LRD and cadaveric kidneys. When compared to the control group, which received only standard antirejection treatment (SAT) of steroid pulsing and local irradiation, the adjunctive ATG treatment group demonstrated significantly faster recovery rates from rejection as well as better graft survival rates (67% versus 91%, respectively, p = .01) after the first rejection. ATG treatment did not result in fewer subsequent rejection episodes than SAT but long-term allograft survival rates remained significantly superior to controls for the entire 3-year study period. By avoiding ATG treatment in those patients who never experienced clinical rejection on maintenance immunosuppressive therapy, i.e. nonresponders (32/130--25%), complications associated with excessive immunosuppression were minimized, i.e., graft and patient survival were 100%. The combined results in a 1-year patient survival of 97% and graft survival of 84%. These results suggest that use of ATG therapeutically for the treatment of rejection is efficacious and may be superior to the prophylactic method of ATG treatment in renal transplant patients.