Antilymphocyte globulin versus OKT3 induction therapy in cadaveric kidney transplantation: a prospective randomized study.
Different induction therapies have been used in renal transplantation to avoid cyclosporine (CsA) nephrotoxicity and early acute graft rejection. This study compares the efficacy of a short course of prophylactic OKT3 to that of antilymphocyte globulin (ALG) in preventing acute renal allograft rejection when administered concomitantly with CsA and steroids. Between March 1988 and December 1990, 140 first-cadaver renal transplant recipients were randomly allocated to two immunosuppression groups--ALG group (n = 68): ALG 15 mg/kg just before transplant surgery, ALG 12 mg/kg the first day after transplant, followed by four doses of 10 mg/kg on alternate days; and OKT3 group (n = 72): OKT3 5 mg just before transplant, followed by four doses of 5 mg/d. Both groups included low-dose CsA and steroids. The incidence of rejection during the first 3 months after transplantation was 15% in the ALG group and 19% in the OKT3 group (NS). Kaplan-Meier estimates of patients free of rejection at 2 years was 85% in the ALG group and 77% in the OKT3 group (NS). The 3-year actuarial graft survival was 82% and 85% (NS), and 3-year patient survival was 97% and 98% (NS), in the ALG and OKT3 groups, respectively. These results indicate that the concomitant association of CsA and ALG or OKT3 constitutes a safe and effective therapeutic strategy that provides a low incidence of rejection and gives good results for patient and graft survival.
Grino
J M
JM
Department of Nephrology, Hospital de Bellvitge, University of Barcelona, Spain.
Castelao
A M
AM
Serón
D
D
Gonzalez
C
C
Galceran
J M
JM
Gil-Vernet
S
S
Andrés
E
E
Mestre
M
M
Torras
J
J
Alsina
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000209:etiology; D017252:CD3 Complex / Q000032:analysis; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000502:physiology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D015166:Monitoring, Immunologic; D016853:Muromonab-CD3 / Q000009:adverse effects / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D015996:Survival Rate
D000961:Antilymphocyte Serum; D017252:CD3 Complex; D016853:Muromonab-CD3; D016572:Cyclosporine; D011241:Prednisone; D008775:Methylprednisolone