PMID: 9193840Jun 1, 1997Paper

Sequential biological immunosuppression. Induction therapy with rabbit antithymocyte globulin

Clinical Transplantation
R D Guttmann, C Flemming

Abstract

This paper describes 108 consecutively treated patients receiving 109 cadaveric (CD) and living donor (LD) renal allografts using a protocol of quadruple sequential immunosuppression with a rabbit anti-human thymocyte IgG (Thymoglobuline), azathioprine, tapering corticosteroids, and delayed introduction of cyclosporine A. The average length of induction was 6.1 d with an average Thymoglobuline dose of 2.0 mg/kg/d. The mean serum creatinine pre-transplant of the cohort was 877 +/- 263 (sd) mumol/L, 146 +/- 44 mumol/L by 3 months post-transplant, and 136 +/- 40 mumol/L at 1 yr. The overall 4-yr actuarial patient survival was 96.6%, and allograft survival was 88.6% at 2 yr and 83.6% at 4 yr. The incidence of acute rejection episodes defined by intention to treat was 32%. Additionally, eight patients in this series received retreatment with Thymoglobuline for a first acute rejection, and only one of these had a second rejection. This was in contrast to 5/11 recurrent rejections following steroid treatment only, and 5/13 recurrences following OKT3 treatment for the first rejection episode. The side-effect profile of Thymoglobuline was largely benign, and the biological agent was well tolerated with initial fever in 75%, chills in 27...Continue Reading

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