Optimal management of induction therapy with ATG in kidney allograft recipients

In vascularized organ grafts donor-specific sensitization is initialed imme diately after vascularization by anastomosis of donor and recipient vessels . Therefore, from an immunological point of view antilymphocytic antibodies should be used in an effective dosage and at an appropriate lime to guaran tee an immediate and strong effect on the recipient's immune system before it recognizes the donor antigenic profiles. On February 8, 1990, the first kidney graft recipients were intraoperatively treated in our center with a high-dose single ATG-Fresenius bolus (9 mg/kg body weight). In all patients basic immunosuppression consisted of azathioprine, cyclosporine and predni solone [triple drug therapy (TDT)]. In a first series we compared TDT vs. T DT + ATG-bolus in nonsensitized recipients as well as TDT + ATG-bolus vs. T DT + ATG 8-day course in sensitized and/or retransplanted recipients. Encou raged by the results of the ATG-bolus groups, we extended this new type of induction to all of our recipients. in this study we present data of 379 AT G-bolus treated kidney graft recipients. Short-term effects were an enhance d rate of immediately functioning grafts, a reduced rate of overall and ste roid-resistant rejections as well as a delayed onset of rejections. The lon g-term effects included significantly improved graft and patient survival.