ANTILYMPHOCYTE INDUCTION IMMUNOSUPPRESSION IN THE POST-MINNESOTA ANTILYMPHOCYTE GLOBULIN ERA - INCIDENCE OF RENAL DYSFUNCTION AND DELAYED GRAFT FUNCTION - A SINGLE-CENTER EXPERIENCE

Between 4/91 and 12/93, 262 patients received cadaveric (CRT) (n=205) or living donor (LRT) (non-HLA identical) renal transplants. All patie nts were treated with the same sequential induction immunosuppression protocol, with the exception of different forms of antilymphocyte sera : either Minnesota antilymphocyte globulin (MALG), antithymocyte globu lin (ATG), orthoclone antibody (OKT3), d 1 postoperatively, or OKT3 in traoperatively. With the withdrawal of MALG from the market, we wished to prospectively analyze the influence of these other antilymphocyte therapies on the incidence of delayed graft function (DGF) (the requir ement for hemodialysis within the first week postoperatively) and rena l function during the first 3 d postoperatively and during the subsequ ent 6 months post-transplantation and compare that with our MALG exper ience. Of the 205 CRT, 76 received MALG with a DGF rate of 18.4%, 50 r eceived ATGAM with a DGF rate of 22.0%, 38 received OKT3 postoperative ly with a DGF rate of 39.5%, and 41 received OKT3 intraoperatively wit h a DGF rate of 39%. Of the 57 LRT, only two patients, one receiving i ntraoperatively OKT3 (secondary to graft thrombosis), and one MALG pat ient, suffered DGF. Serum creatinine values were obtained from postope rative d 1 through postoperative d 4 for 185 patients. Each of the fou r groups showed similar mean decrements in serum creatinine. The numbe r of grafts functioning at 1, 2, 3 and 6 months postoperatively and se rum creatinine values were not statistically different between the gro ups. We conclude that induction immunosuppression with MALG and ATGAM is associated with a lower DGF rate than OKT3 given either intraoperat ively or postoperatively. However, with 6 months of follow-up, we do n ot observe any difference in the incidence of rejection or graft funct ion between the therapies. Consequently, we have chosen ATGAM as our p referred inductive therapy in the absence of MALG owing to its lower a ssociated DGF rate.