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PubMedDate not supplied

Does short-course induction with OKT3 improve outcome after heart transplantation? A randomized trial.

OKT3 is often used routinely for induction immunotherapy or selectively to avoid acute cyclosporine nephrotoxicity in heart transplant recipients at high risk for immediate postoperative kidney failure. It has not been shown in a randomized trial to be useful in patients at low risk for early kidney failure. We randomized 30 patients with a serum creatinine level of less than 1.4 mg/dl before heart transplantation to be treated with triple-drug immunotherapy with cyclosporine, which was started before surgery, (group 1) or to be treated with OKT3 for 4 to 6 days after surgery with oral cyclosporine, which was started between days 2 and 4, after renal function had stabilized (group 2). Follow-up for 6 months revealed no significant differences in the total number of rejection episodes, total number of infections, or in the serum creatinine level. Four patients in group 1 and five patients in group 2 have had no rejection. OKT3 showed a trend to delay time to first rejection (p = 0.10), as has been reported for the 14-day induction course of OKT3. A short course of OKT3 induction in heart transplant recipients at low risk for immediate postoperative kidney failure prolongs the time to first rejection for most patients but does not appear to reduce the total incidence of rejection in the first 6 months after heart transplantation.

Creatinine↗
PubMed1995

Efficacy of rejection prophylaxis with OKT3 in renal transplantation. Collaborative Transplant Study.

The results of renal cadaver transplants performed between 1984 and 1994 and reported to the Collaborative Transplant Study were analyzed to examine the effect of rejection prophylaxis with OKT3. OKT3 prophylaxis with sequential (i.e., delayed) addition of cyclosporine (CsA), compared with immunosuppressive treatment that included CsA but not OKT3, resulted in a significantly higher overall 3-year graft survival rate in recipients of first transplants (75 +/- 1% vs. 71 +/- 1%, respectively; P < 0.0001) and in recipients of retransplants (68 +/- 2% vs. 62 +/- 1%, respectively; P < 0.001). In contrast, the simultaneous administration of OKT3 and CsA from the first posttransplant day did not result in improved graft survival over treatment with CsA alone. Graft survival rates were significantly associated with matching for HLA-A, -B, and -DR antigens in both first and retransplant recipients treated with a sequential protocol of OKT3/CsA (P < 0.01). Among patients with preformed panel reactive lymphocytotoxic antibodies > 50%, significantly better 3-year graft survival rates were obtained with sequential OKT3/CsA than were achieved without OKT3 in first transplant recipients (80 +/- 5% vs. 63 +/- 1%, respectively; P < 0.001) and in retransplant recipients (73 +/- 5% vs. 58 +/- 1%, respectively; P < 0.01). Significantly improved 3-year graft survival rates with OKT3 and sequential CsA were likewise obtained in two other groups of high-risk patients: black recipients (P < 0.001) and pediatric recipients (P < 0.01). The results demonstrate an advantage for OKT3 prophylaxis in conjunction with delayed CsA therapy among renal transplant recipients at high immunological risk, particularly among presensitized patients.

Black People↗
PubMed1995

Long-term ganciclovir prophylaxis eliminates serious cytomegalovirus disease in liver transplant recipients receiving OKT3 therapy for rejection.

We conducted a trial of long-term ganciclovir prophylaxis for prevention of cytomegalovirus (CMV) disease in liver transplant recipients receiving OKT3 therapy for rejection. Intravenous ganciclovir (6 mg/kg once a day, Monday through Friday) was initiated on the same day OKT3 therapy was started and continued for 4 or more weeks. Fifty-one consecutive adult patients (80% CMV seropositive, 20% CMV seronegative) were evaluated. Due to the patient's noncompliance or the primary physician's decision, 6 patients received less than 2 weeks of ganciclovir. Three of these 6 (50%) developed CMV disease (hepatitis 1, CMV syndrome 2). In contrast, of 45 patients receiving 4 or more weeks of prophylactic ganciclovir, only 1 (2.2%) developed CMV disease (hepatitis). There were no cases of CMV disease among 29 patients who received 6 or more weeks of ganciclovir. Reversible neutropenia in 2 patients (4.4%) was the only side effect associated with long-term ganciclovir. Complications from central intravenous catheters did not occur. These results suggest that CMV can be eliminated as a significant pathogen in liver transplant recipients receiving OKT3 for rejection by the long-term administration of prophylactic gnaciclovir, which is safe.

Adult↗
PubMed1995

Remission of a lymphoproliferative disorder occurring after second BMT from an unrelated donor in a 5-year-old boy with severe aplastic anemia.

A 5-year-old boy with severe aplastic anemia failed to respond to cyclosporine (CYA), prednisolone and antilymphocyte globulin (ALG). No suitable sibling marrow donor was available, but an HLA-matched unrelated donor was identified. The patient was conditioned with cyclophosphamide (CY), 50 mg/kg/day for 4 days, total nodal irradiation (8 Gy), and ALG 30 mg/kg/day for 3 days. GVHD prophylaxis consisted of daily CYA, methotrexate (MTX) and ALG. The patient failed to achieve sustained engraftment. He was reconditioned with high-dose prednisolone and anti-T lymphocyte monoclonal antibody OKT3. The boy was reinfused with the same donor marrow on day 0 (+49/first BMT). No GVHD prophylaxis was given the second time. He received G-CSF on days 0 to +20 after the second transplant. Full engraftment was achieved on day +16 (+65). However, on day +31 (80) he developed a biopsy-proven B cell lymphoproliferative disorder (BLPD). After the OKT3 administration was stopped and treatment with ganciclovir and high-dose immunoglobulin was initiated, the BLPD resolved and the patient was discharged on day +50 (99). He is currently well with a functioning graft 266 (305) days posttransplant, with no sign of GVHD.

Anemia, Aplastic↗