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EXPERIENCE WITH ANTITHYMOCYTE GLOBULIN (ATG) IN PEDIATRIC RENAL TRANSPLANT RECIPIENTS

The efficacy of ATG (ATGAMR-Upjohn Co.) in prolonging patient + cadaver renal allograft survival was studied in 21 patients,age 5 to 19 yrs receiving transplants from May 1977 to Oct.1979. Of the 9 patients randomly selected to receive ATG, 3 were given a fixed dose for the 28 day period of therapy; the daily doses of 3 were altered in relation to the percentage of rosette forming cells. Six of the selected patients received the full course of therapy; 1 patient had a positive skin test to ATG; 2 had untoward reactions to the first (and only) administered dose. Of those receiving ATG 1 had irreversible rejection 1 mo after transplantation, and 1 kidney was rejected after 3 mo. Three control patients experienced irreversible rejection within 1 mo, + 2 kidneys were rejected after 3 mos. All patients except 1 experienced threatened rejection episodes during the first mo. One patient died at 2 wks and 2 died within 1 yr after transplantation. All 3 were controls. The 5 treated patients with functioning allografts 4 mos to 2 yrs after surgery had creatinine clearances from 42 to 91 m1/min/1.73M2; 7 controls had clearances from 22 to 120 m1/min/1.73M2. Conclusions: Although the number of patients was very small, there appeared to be no correlation between patient and graft survival and ATG therapy. There was a correlation between graft survival and HLA matching.