The Use of Heterologous Antilymphocyte Globulin (alg) in Human Renal and Liver Transplantation.

Early in 1967, preliminary reports were made from our institutions (Starzl, Marchioro et al. 1967; Starzl, Porter et a/., 1967) of the first clinical use of heterologous antilymphocyte globulin (ALG). T h ~ s immunosuppressive agent was prepared from the serum of horses that had been immunized against cadaveric lymphoid tissue, especially spleens (Iwasaki et al., 1967). It was added to therapy with standard anti-rejection drugs, azathioprine and prednisone, and its use was restricted to the first 4 postoperative months. The evidence then was that ALG was of value at least in avoiding some of the problen~s which were present early after renal homotransplantation. Because ALG was used only during the first months after transplantation, an important unanswered question was whether late rejection would be a serious problem after the foreign protein administration was stopped. Evidence is now available on this point since the survivors amongst the first 20 patients who received consanguineous homografts are 11 to 17 months postoperative; their last ALG injections were 7 to 13 months ago. The present report will beconcerned with a summary follow-up of these early cases; a more detailed analysis is being published elsewhere (Starzl, Groth, Terasaki etal., 1968). Inaddition a brief description will be given of 4 patients who received orthotopic transplantation of cadaveric livers while under therapy with the same immunosuppressive regimen.