Monoclonal antibody OKT3 therapy in pediatric kidney transplant recipients.
Thirty-one pediatric patients with acute renal allograft rejection were treated with the monoclonal antibody OKT3. In 24 cases, increased doses of steroids followed by a polyclonal antithymocyte globulin were ineffective in reversing the rejection episode. Twenty-eight patients completed the prescribed minimum 10-day treatment course, with effective rejection reversal in 22. Three patients failed to complete the course of therapy: one because of leukopenia that developed after the first dose, one because of a clotted graft, and another because of symptomatic cytomegalovirus infection. The overall success rate of OKT3 for rejection reversal was 74%; however, 55% of recipients had rebound rejection, and 85% of patients had detectable anti-OKT3 antibodies after completion of the course of therapy. Ten patients were treated with a second course of OKT3, and in eight of these patients, rejection was at least temporarily reversed. The starting dose of OKT3 for second-course therapy was the same as that used during first-course therapy, but in five cases the dose was increased during the course because of inadequate therapeutic response. Seven of these patients lost their grafts a mean of 6.5 months after completion of second-course therapy. We looked for anti-OKT3 antibody in nine recipients after completion of a second treatment course and found it in all nine. Our observations regarding a second treatment course with this monoclonal antibody preparation suggest that although rejection reversal may be observed, ultimate graft survival is poor and anti-OKT3 antibody formation is enhanced.
Leone
M R
MR
Renal Transplant Service, Oregon Health Sciences University, Portland.
Barry
J M
JM
Alexander
S R
SR
Melvin
T
T
Striegel
J
J
Reller
K
K
Henell
K R
KR
Kimball
J
J
Funnell
M B
MB
Goldstein
G
G
D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D015703:Antigens, CD / Q000032:analysis; D000945:Antigens, Differentiation, T-Lymphocyte / Q000032:analysis; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D017252:CD3 Complex; D002648:Child; D002675:Child, Preschool; D004155:Diphenhydramine / Q000627:therapeutic use; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A; D007223:Infant; D016030:Kidney Transplantation / Q000276:immunology*; D008775:Methylprednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011948:Receptors, Antigen, T-Cell / Q000032:analysis; D012008:Recurrence; D013601:T-Lymphocytes / Q000276:immunology
D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D015703:Antigens, CD; D000945:Antigens, Differentiation, T-Lymphocyte; D000961:Antilymphocyte Serum; D017252:CD3 Complex; D007070:Immunoglobulin A; D011948:Receptors, Antigen, T-Cell; D000082:Acetaminophen; D004155:Diphenhydramine; D001379:Azathioprine; D011241:Prednisone; D008775:Methylprednisolone