TREATMENT OF RENAL TRANSPLANT REJECTION EPISODES IN PATIENTS RECEIVING PREDNISONE AND AZATHIOPRINE

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Abstract
Antilymphocyte globulin (ALG) has been advocated for the treatment of renal transplant rejection episodes in patients maintained on prednisone and azathioprine. Treatment with steroids (outpatient) is considerably less expensive than with ALG (inpatient), so whether routine ALG was necessary was studied. Between March 1982 and Nov. 1983, 54 cadaver transplant recipients maintained on prednisone and azathioprine who developed a 1st rejection episode were randomized to receive (for treatment of their 1st, and, if necessary, 2nd rejection) methylprednisolone (MP) plus ALG (n = 24), or MP alone, with ALG added if treatment failed (n = 30). Treatment failure was defined as continuing deterioration on T131 iodohippuran scan, rising serum creatinine level, or lack of improvement within 7 days. There was no significant difference in patient survival, graft survival, mean number of rejections and infection rate between the 2 groups: 60% (18/30) of 1st and 50% (10/10) of 2nd rejection episodes responded to MP alone. Patients are not penalized by initial rejection treatment with MP. Many rejection episodes respond to steroids alone; elimination of routine ALG use will save hospitalization time and expense.