A prospective study of prophylactic ATG versus cyclosporine in regrafted and highly sensitized renal allograft recipients

The risk of graft loss is much higher in patients receiving their second or subsequent cadaver renal allografts and also in recipients with high levels of panel-reactive antibodies. Steroid-resistant rejection is seen much more commonly in this group of patients than in those receiving primary allografts. We have previously reported the successful use of antithymocyte globulin (Merrieux) to reverse steroid-resistant rejection. However, the late introduction of ATG, after the patient became dialysis-dependent, was a common cause of failure. In our experience these high-risk grafts are under greatest threat during the first 2 weeks. We have conducted a prospective randomized study in order to investigate whether or not the prophylactic use of ATG will prevent aggressive steroid-resistant rejection and graft loss in this high-risk group (DBO).