Efficacy of OKT3 monoclonal antibody therapy in steroid-resistant, predominantly vascular acute rejection. A report of three cases with morphologic and immunophenotypic evaluation.
We describe three patients who became oliguric and uremic in the early posttransplantation period. Following treatment with pulse methylprednisolone, all had biopsy evidence of severe residual rejection that was predominantly vascular. T cells formed the bulk of the infiltrates. Subsequent treatment with the monoclonal antibody OKT3 was associated with an immediate diuresis and improvement in serum creatinine. Repeat renal biopsy, obtained in clinical remission, in two of the three patients, showed marked improvement in the vascular lesions. All three patients maintain normal renal function 9, 13, and 18 months later. We conclude that OKT3 was effective in reversing steroid-resistant rejection despite a predominantly vascular pattern of cellular infiltration not usually considered amenable to any antirejection therapy.
Delaney
V B
VB
Department of Medicine, Emory University Hospital, Atlanta, Georgia 30322.
Campbell
W G
WG
Nasr
S A
SA
McCue
P A
PA
Warshaw
B
B
Whelchel
J D
JD
D000208:Acute Disease; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001167:Arteritis / Q000209:etiology / Q000473:pathology / Q000628:therapy; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects*; D010641:Phenotype; D013601:T-Lymphocytes / Q000145:classification / Q000473:pathology; D014657:Vasculitis / Q000209:etiology / Q000473:pathology / Q000628:therapy*
D000911:Antibodies, Monoclonal; D008775:Methylprednisolone