SINGLE-SHOT, HIGH-DOSE RABBIT ATG FOR REJECTION PROPHYLAXIS AFTER KIDNEY-TRANSPLANTATION

We studied the effects of a single intravenous injection of rabbit ATG (RIVM, Bilthoven, The Netherlands) in a dose of 8 mg/kg body weight a dministered 6 h after kidney transplantation on graft survival, reject ion incidence, T-cell subsets, and cost-effectiveness. A total of 58 ( 37 male/21 female) consecutive renal allograft recipients were entered in this trial. Treatment results were compared with 56 patients treat ed with intravenous cyclosporin (CyA). In all patients concomitant med ication consisted of steroids and azathioprine, followed by oral CyA. Following rabbit ATG, T cells (WT31) quickly disappeared from the peri pheral blood and a return to greater than 100/mm3 was observed at a me dian of 7 (range 3-21) days. Graft survival was the same in both group s, as was the incidence of primary nonfunction. The rate of acute reje ction was significantly lower in the rabbit ATG-treated patients (12% vs 50%). We conclude that a single shot of rabbit ATG is an attractive , easy, and cost-effective induction scheme with a low incidence of de layed graft function and acute rejection episodes. A relatively high i ncidence of vascular thrombosis of the graft, however, warrants furthe r study before this treatment regimen can be generally applied.