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Title: Graft irradiation in the treatment of acute rejection of renal transplants: a randomized study

Abstract

A randomized study of graft irradiation in the treatment of acute rejection of renal transplants was conducted from 1978 to 1981. Patients developing clinical signs of an acute graft rejection received customary antirejection treatment in the form of intravenous administration of high-dose (1 gm per day) of methylprednisolone. They were at the same time randomized to either receive therapeutic irradiation (175 rad every other day to a total of 525 rad) or sham irradiation. Neither the patient nor the Transplant Service surgeons knew at any time whether the radiation treatment had been given. Eighty-three rejection episodes occurring in 64 grafts were entered into the study. Acute rejection was reversed in 84.5% of grafts in the control and 75% in the treated group. The incidence of recurrent rejection was higher in the treated group (66 vs. 46%) and graft survival was lower (22% vs. 54%). The study failed to demonstrate a beneficial effect of graft irradiation in the treatment of acute renal allograft rejection, when used in conjunction with high dose steriods.

Authors:
; ; ; ; ;
Publication Date:
Research Org.:
Washington Univ. School of Medicine, St. Louis, MO
OSTI Identifier:
6716722
Alternate Identifier(s):
OSTI ID: 6716722
Resource Type:
Journal Article
Resource Relation:
Journal Name: Int. J. Radiat. Oncol., Biol. Phys.; (United States); Journal Volume: 8:5
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; GRAFTS; LOCAL IRRADIATION; IMMUNOSUPPRESSION; RADIOINDUCTION; KIDNEYS; TRANSPLANTS; RADIOTHERAPY; EVALUATION; GRAFT-HOST REACTION; IONIZING RADIATIONS; PATIENTS; STEROIDS; BODY; IRRADIATION; MEDICINE; NUCLEAR MEDICINE; ORGANIC COMPOUNDS; ORGANS; RADIATIONS; RADIOLOGY; THERAPY 550603* -- Medicine-- External Radiation in Therapy-- (1980-)

Citation Formats

Pilepich, M.V., Anderson, C.B., Etheredge, E.E., Sicard, G.A., Melzer, J.S., and Blum, J. Graft irradiation in the treatment of acute rejection of renal transplants: a randomized study. United States: N. p., 1982. Web. doi:10.1016/0360-3016(82)90084-0.
Pilepich, M.V., Anderson, C.B., Etheredge, E.E., Sicard, G.A., Melzer, J.S., & Blum, J. Graft irradiation in the treatment of acute rejection of renal transplants: a randomized study. United States. doi:10.1016/0360-3016(82)90084-0.
Pilepich, M.V., Anderson, C.B., Etheredge, E.E., Sicard, G.A., Melzer, J.S., and Blum, J. Sat . "Graft irradiation in the treatment of acute rejection of renal transplants: a randomized study". United States. doi:10.1016/0360-3016(82)90084-0.
@article{osti_6716722,
title = {Graft irradiation in the treatment of acute rejection of renal transplants: a randomized study},
author = {Pilepich, M.V. and Anderson, C.B. and Etheredge, E.E. and Sicard, G.A. and Melzer, J.S. and Blum, J.},
abstractNote = {A randomized study of graft irradiation in the treatment of acute rejection of renal transplants was conducted from 1978 to 1981. Patients developing clinical signs of an acute graft rejection received customary antirejection treatment in the form of intravenous administration of high-dose (1 gm per day) of methylprednisolone. They were at the same time randomized to either receive therapeutic irradiation (175 rad every other day to a total of 525 rad) or sham irradiation. Neither the patient nor the Transplant Service surgeons knew at any time whether the radiation treatment had been given. Eighty-three rejection episodes occurring in 64 grafts were entered into the study. Acute rejection was reversed in 84.5% of grafts in the control and 75% in the treated group. The incidence of recurrent rejection was higher in the treated group (66 vs. 46%) and graft survival was lower (22% vs. 54%). The study failed to demonstrate a beneficial effect of graft irradiation in the treatment of acute renal allograft rejection, when used in conjunction with high dose steriods.},
doi = {10.1016/0360-3016(82)90084-0},
journal = {Int. J. Radiat. Oncol., Biol. Phys.; (United States)},
number = ,
volume = 8:5,
place = {United States},
year = {Sat May 01 00:00:00 EDT 1982},
month = {Sat May 01 00:00:00 EDT 1982}
}
  • To evaluate the effect of graft irradiation in the treatment of acute rejection of renal transplants, a randomized study was conducted from 1978 to 1981. Patients with acute rejection were given standard medical management in the form of intravenous methylprednisolone, and were chosen randomly to receive either graft irradiation (175 rads every other day, to a total of 525 rads) or simulated (sham) irradiation. Eighty-three rejections occurring in 64 grafts were randomized to the protocol. Rejection reversal was recorded in 84.5% of control grafts and 75% of the irradiated grafts. Recurrent rejections were more frequent and graft survival was significantlymore » lower in the irradiated group (22%) than in the control group (54%). Graft irradiation does not appear to be beneficial in the treatment of acute rejection of renal transplants when used in conjunction with high-dose steroids.« less
  • A prospective randomized study investigating the effectiveness of adjuvant local graft irradiation (LGI) following renal transplantation was performed at Georgetown University Hospital from 1983 until 1988. One hundred and thirty-eight patients were enrolled in the study with 117 patients receiving cadaver kidney transplantations and 21 patients receiving living related kidney transplantations. Seventy-one patients were randomized to receive adjuvant local graft irradiation consisting of 600 cGy in four fractions with chemical immunosuppression whereas the remaining 67 patients received chemical immunosuppression only (control group). The two groups were comparable at entry with respect to potentially important prognostic variables. Median follow-up for allmore » patients was 30 months. The 3-year actuarial allograft success rate was 75% and 68% for the local graft irradiation and control groups, respectively. A nonsignificant trend favoring the irradiated group was noted. Subgroup analysis of the 21 recipients of kidneys from living related donors suggested an improvement in allograft survival for the local graft irradiation arm. Cadaver allograft survival was not significantly different between the two treatment arms. There was no apparent benefit in kidney function or time to the first rejection episode in the group receiving local graft irradiation.« less
  • Acute graft-versus-host disease is a major problem in allogeneic bone-marrow transplantation. We performed a randomized study to compare the effectiveness of two regimens in the prevention of acute graft-versus-host disease. Thirty-five patients received methotrexate alone, and 32 received methotrexate, antithymocyte globulin, and prednisone. Of the patients who received methotrexate alone, 48 percent had acute graft-versus-host disease, as compared with 21 per cent of those who received methotrexate, antithymocyte globulin, and prednisone (P = 0.01). The age of the recipient was a significant factor in the development of acute graft-versus-host disease: Older patients had a higher incidence of the disease (Pmore » = 0.001). We conclude that the combination of methotrexate, antithymocyte globulin, and prednisone significantly decreased the incidence of acute graft-versus-host disease and should be used to prevent this disorder in patients receiving allogeneic marrow transplants.« less