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ATG useful in transplant patients as substitute for steroids

Anti-thymocyte globulin (ATG), a compound made from rabbit antibodies appears to be as effective as routine steroids in reducing rejection of transplanted organs without any of the side effects, according to Dr. James Eason of the Ochsner Multi-Organ Transplant Center in New Orleans. In the largest study on steroid-free treatment of liver transplants, Dr. Eason found patients treated with ATG had lower rejection and severity rates than patients who received standard steroid treatment. Also the acute rejection was 33% lesser in these patients.

Rejection was reversed in all patients who received rabbit ATG by increasing the anti-rejection drug alone, while 60 percent of patients in the steroid group required additional steroids for reversal. These findings were presented by Dr. Eason at Transplant 2001, the joint meeting of the American Society for Transplantation and the American Society of Transplant Surgeons.

Rabbit ATG is a purified, pasteurized, gamma immune globulin, obtained by immunization of rabbits with human thymocytes, which contains cytotoxic antibodies expressed on human T-lymphocytes. Steroids have been considered a key component of liver transplant treatment, even though they are associated with adverse side effects. When a patient receives an organ transplant, the body's white blood cells often try to reject the new organ .It is here that ATG steps in. The rabbit ATG works to prevent this from happening without the problems caused by steroids.

Unlike traditional long-term steroid treatment, normally used to reduce swelling and inflammation following organ transplant, Eason said patients receive rabbit ATG for just two days, the first dose during the transplant itself. The study found 4 percent of steroid-free patients developed post-transplant diabetes, compared to 14 percent in the steroid group, and only 50 percent of those receiving rabbit ATG developed recurrent hepatitis C or diabetes, compared to 70 percent of those on steroid treatment.

For those who are contemplating transplants but are worried about rejections and other steroid induced reactions these words of Dr. Eason will sound musical to their ears. But for a comprehensive analysis of ATG, one has to wait and watch the long-term effects. If it continues its good work, ATG will reduce the steroid related side effects and costs for patients, on life long immunosuppressive therapy to guard against transplant rejection, in a big way.

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