Clinical Use of Rabbit Antihuman Lymphocyte Globulin in Cadaver-Kidney Transplantation

Twenty-six consecutive recipients of cadaver-kidney transplants were treated with rabbit antihuman lymphocyte globulin (ALG) in addition to conventional immunosuppressive therapy. Each of the first 10 of these recipients has been followed for more than 12 months. The one-year transplant survival in this group was 90 per cent. Rabbit ALG administration was well tolerated. Most patients had no symptoms related to ALG injections. There were four acute transplant rejection episodes in the first 10 patients and four episodes in 16 subsequent patients followed for more than four months. All acute rejection episodes occurred six weeks or more after transplantation, and all were easily and promptly reversed by a temporary increase in the dose of steroid therapy. Immediate, hyperacute rejection by preformed antibodies was the only cause of kidney transplant loss in the entire series. ALTHOUGH antilymphocyte globulin (ALG) has been used as an immunosuppressive agent in clinical organ transplantation since 1966,¹ and a number of groups have been impressed that it has favorably influenced transplant survival,^{1 2 3 4 5} interpretation of the results of ALG administration to human transplant recipients is difficult for several reasons. In the first place, ALG has invariably, and perhaps unavoidably, been used in conjunction with other immunosuppressive therapy of proved effectiveness, and the exact contribution of ALG to the results achieved is unclear. Secondly, titers of antilymphocyte antibodies in ALG preparations, as measured in vitro by leukoagglutinating or leukocytoxicity technics, do not.