Figure 99

Immunosuppressive therapy protocols. Standard immunosuppressive therapy in renal transplant recipient consists of 1) baseline therapy to prevent rejection, and 2) short courses of antirejection therapy using high-dose methylprednisolone, monoclonal antibodies or polyclonal antisera such as antilymphocyte globulin (ALG) and antithymocyte globulin (ATG).

Antilymphocyte globulin is prepared by immunizing rabbits or horses with human lymphoid cells derived from the thymus or cultured B-cell lines. Disadvantages of using polyclonal ALS include lot-to-lot variability, cumbersome production and purification, nonselective targeting of all lymphocytes, and the need to administer the medication via central venous access. Despite these limitations, ALG has been used both for prophylaxis against and for the primary treatment of acute rejection. A typical recommended dose for acute rejection is 10 to 15 mg/kg daily for 7 to 10 days. The reversal rate has been between 75% and 100% in different series. In contrast to murine monoclonal antibodies (eg, OKT3), ALS does not generally induce a host antibody response to the rabbit or horse serum. As a result, there is a greater opportunity for successful readministration.

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