Clinical Investigation

Kidney International (1981) 19, 438–444; doi:10.1038/ki.1981.37

Antithymocyte globulin in cadaver kidney transplantation: A randomized trial based on T-cell monitoring

Henri Kreis1, Rafik Mansouri1, Jean-Michel Descamps1, Raymond Dandavino1, Ann Thu N'Guyen1, Jean François Bach1 and Jean Crosnier1

1Département de Thérapeutique Néphrologique, Hôpital Necker, Paris, France

Correspondence: Dr H Kreis, Unité de Transplantation Rénale, Hôpital Necker, 161 rue de Sèvres, 75730 Paris, Cedex 15, France

Received 29 October 1979; Revised 30 April 1980.

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Abstract

Antithymocyte globulin in cadaver kidney transplantation: A randomized trial based on T-cell monitoring. The influence of horse antihuman thymocyte globulin (ATG) on renal allograft survival was assayed between March 1977 and August 1978. Fifty consecutive patients were randomly assigned to the treatment or the control group. Patients in both groups received azathioprine and prednisolone. ATG was added in the experimental group. The daily dosage was such as to maintain the rosette-forming cell (RFC) level at 10% of baseline values. The number of renal failure episodes (RFE's) was significantly lower in the experimental group during the period (1 month) ATG was given than it was in the control group during that same period of time. Two years after transplantation, kidney survival was 79% in the ATG group and 52% in the control group. The amount of steroids necessary to control RFE's was significantly lower in the ATG group. The dosages of ATG used in the experimental group were relatively small (average daily dose, 3.08 plusminus 0.26 mg/kg of body wt), and adverse reactions were mild. Blood tolerance was excellent T-cell monitoring thus appears to be an effective method in evaluating the daily dosage of ATG.

Globuline anti-thymocytaire dans la transplantation du rein de cadavre: Etude randomisée fondée sur l'étude de cellules T. L'influence de la globuline anti-thymocytes humaine (ATG) sur la survie d'allogreffe rénale a été évaluée entre Mars 1977 et Août 1978. Cinquante malades consécutifs ont été affectés au hasard au groupe traité ou au groupe contrôle. Les malades des deux groupes ont reçu de l'azathioprine et de la prednisolone. L'ATG a été ajoutée dans le groupe expérimental. La dose quotidienne a été ajustée de telle sorte que les cellules formant des rosettes (RFC) soient maintenues à 10% des valeurs basales. Le nombre d'épisodes d'insuffisance rénale (RFE) a été significativement inférieur durant la période d'un mois pendant laquelle l'ATG a été donnée. Deux ans après la transplantation la survie de la greffe était de 79% dans le groupe ATG et de 52% dans le groupe contrôle. La quantité de stéroïde nécessaire à contrôler les épisodes de rejet a été significativement inférieure dans le groupe ATG. Les doses d'ATG utilisées dans le groupe expérimental ont été relativement faibles (dose quotidienne moyenne 3,08 plusminus 0,26 mg/kg de poids corporel) et les effets secondaires ont été raisonnables. La tolérance sanguine a été excellente. La mesure des cellules T parait être une méthode efficace dans la détermination de la posologie quotidienne de l'ATG.

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References

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