Immediate and long-term results of ATG induction therapy for delayed graftfunction compared to conventional therapy for immediate graft function

The use of polyclonal antibodies for delayed graft function (DGF) was teste d in 83 renal allograft recipients. Conventional immunosuppression (CI) was given to 52 patients with immediate graft function (IGF) while 31 patients with DGF received the polyclonal antibody ATG. Administration of OKT3 was restricted to steroid-resistant acute rejections in both groups. The incide nce and severity of acute rejections, graft survival rate. CMV infections, and lymphocyte subsets were examined. ATG patients experienced a total of 0 .6 acute rejections per patient, whereas CI patients had 0.9 on the average (P < 0.05). Second and third acute rejections occurred less frequently and later in the ATG group than in the CI group (P < 0.01). Steroid-resistant acute rejections occurred in 20 of the CI patients (38 %) but in only 7 of ATG patients (23 %). One-year graft survival in the CI and ATC groups was 9 8.1 % and 93.2 %, respectively. A decreased CD4 + to CD8 + T-lymphocyte rat io of about 0.5 was still detectable 5 years after the initial ATG administ ration. Hence, patients with DGF appear to benefit from induction therapy w ith ATG.