ANTILYMPHOCYTE INDUCTION IMMUNOSUPPRESSION IN THE POST-MINNESOTA ANTILYMPHOCYTE GLOBULIN ERA - INCIDENCE OF RENAL DYSFUNCTION AND DELAYED GRAFT FUNCTION - A SINGLE-CENTER EXPERIENCE
L. Malinow et al., ANTILYMPHOCYTE INDUCTION IMMUNOSUPPRESSION IN THE POST-MINNESOTA ANTILYMPHOCYTE GLOBULIN ERA - INCIDENCE OF RENAL DYSFUNCTION AND DELAYED GRAFT FUNCTION - A SINGLE-CENTER EXPERIENCE, Clinical transplantation, 10(3), 1996, pp. 237-242
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.