Anti-lymphocyte antibodies late in the course of pediatric renal transplantation

Beyond the immediate post-transplant period, physicians are often reluctant to use anti-lymphocyte preparations to treat episodes of acute renal funct ional deterioration attributable to acute rejection. This is due to the per ception that such episodes are less likely to be reversible, and to concern regarding the potential adverse effects of anti-lymphocyte antibodies, inc luding opportunistic infections, lymphoproliferative disorders, and the dev elopment of human anti-mouse antibodies. Records were reviewed for all 365 renal transplants performed in 267 patients at our center from 1971 to 1996 . Anti-lymphocyte antibodies were used in an attempt to reverse 6 episodes of corticosteroid-resistant acute rejection in 5 children at a mean interva l of 24.5 months following transplantation. The mean serum creatinine at in itiation of therapy with the anti-lymphocyte agents was 2.9 mg/dl. Followin g treatment, the mean serum creatinine decreased to 1.3 mg/dl (P=0.03, Stud ent's t-test). Two patients developed uncomplicated opportunistic infection s after completion of anti-lymphocyte therapy; none have developed lymphopr oliferative disorders or antibodies to OKT3. We conclude that in the correc t clinical setting with corticosteroid-resistant acute rejection, the use o f anti-lymphocyte antibodies should not be withheld solely on the basis of length of time since transplantation.