COMPARISON OF MINNESOTA ANTILYMPHOBLAST GLOBULIN AND UPJOHN ANTITHYMOCYTE GLOBULIN FOR INDUCTION IMMUNOSUPPRESSION OF HUMAN RENAL-ALLOGRAFTS

Background. An analysis of heterologous polyclonal antisera in first r enal transplants was continued after replacement of Minnesota antilymp hoblast globulin (MALG) with antithymocyte globulin (ATGAM), testing t he hypothesis that these are functionally equivalent drugs. Methods. S equential induction immunosuppression used MALG (20 mg/kg/day, n = 33) or ATGAM (15 mg/kg/day, n = 14), carticosteroids, azathioprine and cy closporine. White blood cell, platelet, and T-cell subsets were measur ed. Percent of patients with and time to first rejection were determin ed. Anti-horse antibody was measured by enzyme-linked immunosorbent as say. Minimum follow-up after transplantation was 1 year. Results. Huma n leukocyte antigen mismatch, peak and current panel reactive antibodi es, age, gender, percent cadaver donors and diabetic recipients were s imilar. Depletion of CD2, CD3, CD4, and CD8 T-cell subsets and platele t and white blood cells was similar. Early renal function was better w ith MALG than with ATGAM (p = 0.005, ANOVA), but by 2 weeks the groups were similar. The percent of patients receiving MALG versus patients receiving ATGAM with cytomegalovirus (28 versus 50), anti-horse antibo dies (50 versus 62), and rejection (58 versus 50) and the median day o f first rejection (48 versus 47) were similar. Three grafts were lost. Conclusions. MALG and ATGAM are equally effective in eliminating T ce lls and preventing and delaying the onset of renal allograft rejection .