Immunosuppressive therapy antithymocyte globulins

Nonspecific immunosuppressive therapy in an adult patient is usually through cyclosporin (35), started intravenously at the time of transplantation, and given orally once feeding is tolerated. Typically, methylprednisone is started also at the time of transplantation, then reduced to a maintenance dose. A athioprine (31) may also be used in conjunction with the prednisone to achieve adequate immunosuppression. Whereas the objective of immunosuppression is to protect the transplant, general or excessive immunosuppression may lead to undesirable compHcations, eg, opportunistic infections and potential malignancies. These adverse effects could be avoided if selective immunosuppression could be achieved. Suspected rejection episodes are treated with intravenous corticosteroids. Steroid-resistant rejection may be treated with monoclonal antibodies (78,79) such as Muromonab-CD3, specific for the T3-receptor on human T-ceUs. Alternatively, antithymocyte globulin (ATG) may be used against both B- and T-ceUs. 

The antithymocyte globulin (ATG) Fresenius S, produced in rabbits, is an example of a polyclonal antibody mixture used in immunosuppressive therapy in combination with other immunosuppressive agents (e.g., cyclosporine, prednisone) after organ transplantation. 

Anti-thymocyte globulin (ATG, thymoglobulin) is a polyclonal rabbit antithymocyte globulin that has been used as an immunosuppressive agent in kidney and hver transplant patients. Despite a fairly high safety profile, reported side effects of ATG include hypertension, leucopenia and ARDS [109]. Renal adverse effects are extremely rare only two case reports describe the occurrence of acute renal failure in patients treated with ATG [110, 111]. Cessation of ATG therapy in both cases and plasmapheresis in one case resulted in full recovery. 

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