Kidney transplantation with rabbit antithymocyte globulin induction and sirolimus monotherapy.
Renal allograft recipients generally need to take several immunosuppressive agents for life. Calcineurin inhibitors and glucocorticosteroids are the mainstays of most regimens but have undesirable chronic effects. We postulated that aggressive T-cell depletion combined with the newer immunosuppressant sirolimus would permit transplantation without multidrug treatment. We therefore tested T-cell depletion with rabbit antithymocyte globulin followed by sirolimus monotherapy in 12 patients in an open-label study. This approach was tolerated well, and all patients achieved excellent renal function, and most did not need chronic steroid treatment or calcineurin inhibitors. Rejection was typically correlated with low concentrations of sirolimus, indicating continued dependence on maintenance immunosuppression.
Swanson
S John
SJ
Organ Transplant Service, Walter Reed Army Medical Center, Washington, DC, USA.
Hale
Douglas A
DA
Mannon
Roslyn B
RB
Kleiner
David E
DE
Cendales
Linda C
LC
Chamberlain
Christine E
CE
Polly
Shirley M
SM
Harlan
David M
DM
Kirk
Allan D
AD
D000328:Adult; D000818:Animals; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011817:Rabbits; D051437:Renal Insufficiency / Q000209:etiology; D020123:Sirolimus / Q000627:therapeutic use*
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D003404:Creatinine; D020123:Sirolimus