Sequential therapy—a prospective randomized trial of malg versus okt3 for prophylactic immunosuppression in cadaver renal allograft recipients

We prospectively studied the use of prophylactic Minnesota antilymphocyte globulin vs. 0KT3 in kidney transplant recipients. Between 7/1/87 and 9/1/90, 138 adult kidney and 35 kidney-pancreas recipients were randomized after stratification for age (18-49 vs. >50), diabetes (diabetic vs. nondiabetic), transplant number (1 vs. >1) and, for retransplants, the length of survival of the first graft (<1 year vs. >1 year), and then randomized to receive 7 days of either MALG (20 mg/kg/day) or OKT3 (5 mg/day). Immunosuppression was otherwise identical in both groups; prednisone and azathi-oprine started on the day of surgery, and cyclosporine started on postoperative day 6. Minimum follow-up was 9 months. There was no difference in one- and two-year actuarial patient or graft survival rates, incidence of rejection, or serum creatinine level. MALG was associated with a higher incidence of cytomegalovirus; it was statistically significant in the subgroup of CMV seronegative recipients of kidneys from seropositive donors (P<.05). OKT3 was more expensive and was associated with significantly more side effects: Fever (P<.0001), dyspnea (P=.04), and acute respiratory distress syndrome (ARDS) (P=.02).