The effect of serum ALG concentrations on results following renal transplantation.

Seventy-three recipients of renal allografts from cadaver donors, and 121 recipients of kidneys from living related donors were studied to determine whether there were any differences in posttransplant results between patients that had a high average serum concentration of ALG (>/=800 microg/ml) during the two weeks of ALG therapy and patients that had low serum levels (</=799 microg/ml). Cadaver kidney recipients who had high serum ALG levels (average 1126 microg/ml) had significantly fewer rejection episodes three months posttransplant and less kidney loss three and six months posttransplant when compared to patients with low serum ALG concentrations (average 629 microg/ml). The tendencies after three and six months favored the group with high serum ALG levels, but the differences were not statistically significant. There were also significantly fewer rejection episodes and less kidney loss at three months in the group with serum ALG levels >/=800 microg/ml when high risk patients with diabetes mellitus were excluded. There were significantly also fewer rejection episodes at three months in recipients of living related kidney grafts that had serum ALG levels >/=800 microg/ml. When high risk diabetics or patients older than 40 were excluded from the related recipients, the number of rejection episodes was still significantly less in patients with high serum ALG levels. There was significantly less kidney loss 24 and more months posttransplant in recipients of kidneys from living related donors whether or not high risk patients were excluded. These results support previous reports from the University of Minnesota indicating ALG is a safe and effective immunosuppressive agent in renal allograft recipients.