15-Deoxyspergualin is a useful drug for rejection episodes following renal transplantation

Background. 15-Deoxyspergualin (DSG) is a derivative of spergualin, which is an antibiotic extracted from the culture filtrate of Bacillus laterosporus. DSG is reported to be a potent immunosuppressive agent. In this study, we evaluated the ef31ficacy of DSG for rejection following renal transplantation. Methods. The subjects were 15 patients who received a renal transplant. DSG was used against a total of 27 rejection episodes, including 19 acute rejections, 6 acute on chronic rejections, and 2 chronic rejections. DSG was given intravenously to the patients at the dose of 5 mg/kg/day in principle, and the administration period was 5-10 days. We also used methylprednisolone for the first 3 days at the dose of 500 mg (day 1), 250 mg (day 2), and 125 mg (day 3). Results. DSG was effective for all patients with acute rejection, and the serum creatinine values returned to their previous levels in 5 acute rejection episodes. DSG was effective for 4 of the acute on chronic rejection episodes. However, it showed no beneficial effect for 2 acute on chronic rejection episodes. DSG was effective for 1 chronic rejection episode, but it showed no effect on another chronic rejection episode. DSG was effective for 24 of 27 rejection episodes; hence, the efficacy rate was 88.9%. Among the side effects from the use of DSG, facial flushing was the most frequent subjective symptom and thrombocytopenia and leukocytopenia were the main abnormalities among the laboratory data. Most of these adverse effects were mild and well tolerated the patients. Conclusion. In conclusion, DSG showed a beneficial effect against rejection episodes following renal transplantation, especially for acute rejection and acute on chronic rejection episodes.