What should be administered to manage severe renal transplant rejection?

Administering rabbit antithymocyte globulin is a well-established approach for managing severe renal transplant rejection, particularly acute rejection episodes. This medication is an immunosuppressive agent derived from rabbit serum and contains antibodies that target several human T-cell markers. By depleting T-cells, it reduces the immune response that leads to the rejection of the transplanted kidney.

This treatment is particularly effective because acute rejection typically involves a strong cell-mediated immune response, primarily driven by T-lymphocytes. By depleting these cells, rabbit antithymocyte globulin can stabilize and preserve the function of the transplanted organ.

In cases of severe rejection, scaling up the dose of prednisone may not provide sufficient control. Although corticosteroids like prednisone are often part of the immunosuppressive regimen, they may not be sufficient alone to reverse severe acute rejection. Other options such as sirolimus or azathioprine are typically used for maintenance immunosuppression rather than as an immediate response to an acute rejection episode. Therefore, using rabbit antithymocyte globulin directly addresses the underlying mechanism of the rejection and is generally the preferred choice in this scenario.