OKT3 reversal of biopsy‐proven allograft rejection occurring during Minnesota antilymphoblast globulin induction in the pediatric renal recipient

Allograft rejection occurring during induction with antilymphocyte agents is a rare event usually associated with a high risk of allograft loss. In two separate pediatric renal transplant programs. 6 children out of a total of 43 (14%) had biopsy‐proven rejection at 8 ±0.7 days of Minnesota antilymphoblast globulin (MALG) therapy. Conversion to OKT3 resulted in allograft survival in all 6. Of the 6 patients, none had complications of viral illness; yet 2 required a second course of OKT3 and subsequently did develop lymphoproliferative disease (LPD). The LPD in both patients subsided after a decrease in immunosuppression and intravenous acyclovir. Our data support the observation that allograft rejection during MALG induction is common. Rapid identification of rejection by use of an allograft biopsy permits salvage of the allograft with OKT3 therapy. Observation for potential complications of LPD is mandatory because the increase in immunosuppression places the patient at increased risk for viral or LPD complications.