OKT3 treatment of steroid-resistant rejection in pediatric liver transplant recipients.
Of a total of 187 consecutive liver grafts in 149 pediatric recipients, 59 episodes of steroid-resistant, biopsy-proven rejection (32% of grafts) were treated with OKT3 monoclonal antibody. After 59 OKT3-treated episodes, liver function at the end of treatment was normal in 40%, improved in 35%, and unchanged in 24%. Of 21 partial responses, 12 episodes eventually resolved to yield an overall complete response rate of 59%. CD3-positive T-cells greater than 5% occurred during 61% of OKT3-treated rejection episodes and was associated with impaired efficacy of OKT3 (30% complete response rate). Six grafts were re-treated with OKT3 for rejection and in all CD3-positive T-cells could not be maintained less than 5%. Of the six grafts requiring repeat OKT3, five failed-retreatment and required retransplantation. OKT3 antibodies of low titer were found prior to a second use of OKT3 in 65% of episodes. Patients treated with OKT3 after failing more than two preceding steroid courses had a significantly increased chance of graft loss (57%; p = 0.01). We conclude that this group of pediatric patients appeared less responsive to OKT3 compared to other series combining pediatric and adult recipients, possibly due to a more vigorous immune response in the child.
McDiarmid
S V
SV
Department of Pediatrics, UCLA School of Medicine.
Busuttil
R W
RW
Terasaki
P
P
Vargas
J H
JH
Ament
M E
ME
D000906:Antibodies / Q000097:blood; D015703:Antigens, CD / Q000096:biosynthesis; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000209:etiology; D004351:Drug Resistance; D006084:Graft Rejection / Q000187:drug effects*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007958:Leukocyte Count; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008775:Methylprednisolone / Q000627:therapeutic use; D016853:Muromonab-CD3 / Q000276:immunology / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D015996:Survival Rate; D013601:T-Lymphocytes / Q000378:metabolism
D000906:Antibodies; D015703:Antigens, CD; D016853:Muromonab-CD3; D016572:Cyclosporine; D011241:Prednisone; D008775:Methylprednisolone