OKT3 REVERSAL OF BIOPSY-PROVEN ALLOGRAFT-REJECTION OCCURRING DURING MINNESOTA ANTILYMPHOBLAST GLOBULIN INDUCTION IN THE PEDIATRIC RENAL RECIPIENT

Allograft rejection occurring during induction with antilymphocyte age nts is a rare event usually associated with a high risk of allograft l oss. In two separate pediatric renal transplant programs, 6 children o ut of a total of 43 (14%) had biopsy-proven rejection at 8 +/- 0.7 day s of Minnesota antilymphoblast globulin (MALG) therapy. Conversion to OKT3 resulted in allograft survival in all 6. Of the 6 patients, none had complications of viral illness; yet 2 required a second course of OKT3 and subsequently did develop lymphoproliferative disease (LPD). T he LPD in both patients subsided after a decrease in immunosuppression and intravenous acyclovir. Our data support the observation that allo graft rejection during MALG induction is common. Rapid identification of rejection by use of an allograft biopsy permits salvage of the allo graft with OKT3 therapy. Observation for potential complications of LP D is mandatory because the increase in immunosuppression places the pa tient at increased risk for viral or LPD complications.