Intraoperative T cell depletion by ATG as promising therapeutical concept for kidney graft recipients

In a retrospective analysis the data of 356 patients were evaluated who received cadaveric kidney transplants between 1987 and 1993 at the Kidney Transplant Centre Berlin-Friedrichshain. All recipients were treated with a standard immunosuppressive protocol consisting of azathioprine, cyclosporine and prednisolone. In addition 254 out of 356 recipients were intraoperatively infused with 9 mg/kg b.w. anti-T-lymphocyte globuline (ATG-Fresenius). The ATG infusion was always finished before completion of the anastomoses. Already at that time a strong T-cell depletion was detectable lasting for some days. Under anesthetic conditions as well as 0.5 g methylprednisolone given 1 hour before ATG a cytokine-release syndrome was effectively prevented. In comparison to the recipients exclusively treated with a triple-drug combination the recipients with an intraoperative ATG induction therapy showed fewer graft failures in the early post transplant phase (p < 0.05), fewer and later occurring rejection crises (p < 0.05) and a significantly improved 2-year-graft survival rate (74% vs 91%). In spite of an increase of serologically confirmed CMV infections (35% vs 50%, p < 0.05) there were no differences in the frequency of clinical manifestations (p > 0.05). The 2-year-patient survival rate was 96%. Thus, in our centre the intraoperative high-dose single ATG bolus prophylaxis is part of an efficient treatment protocol.