OKT3 serum levels as a guide for prophylactic therapy: a pilot study in kidney transplant recipients.
The use of OKT3 as prophylaxis in renal transplantation results in a reduced incidence of graft rejection and appears to have beneficial effects on long-term kidney graft survival. However, we and others have observed that patients still experience rejection during the period of OKT3 prophylaxis given at the regular 5 mg/day dose. Many of these patients had no circulating CD3+ cells at the time of rejection, but their OKT3 serum levels were distinctly low (< 500 ng/ml). This led us to adjust OKT3 doses (5 or 10 mg) daily, according to the patients' OKT3 levels, in order to maintain an OKT3 concentration of around 1000 ng/ml. In addition, patients were randomized to receive either 5 mg (group 1, n = 15) or 10 ng (group 2, n = 14) OKT3 as the initial three doses. Concomitant immunosuppression consisted of azathioprine and steroids, with the introduction of cyclosporin A on day 11. Patient survival was 100% after 3 months of follow-up. The intensity of OKT3 first-dose reactions was similar in both groups. Intragraft thrombosis, initially observed in a previous group of patients who received a fixed 10 mg/day OKT3 prophylaxis, occurred in three patients in group 1 and resulted in two graft losses. The cumulative OKT3 dose was similar in both groups (mean +/- SEM 98 +/- 2 mg in group 1 vs 102 +/- 3 mg in group 2) and higher than the 70 mg usually administered. Group 2 patients had higher OKT3 serum levels during the first 4 days of therapy. No correlation could be found between patient weight and cumulative OKT3 dose (r = 0.29).(ABSTRACT TRUNCATED AT 250 WORDS)
Abramowicz
D
D
Department of Nephrology, Dialysis and Transplantation, Hopital Erasme, Brussels, Belgium.
Goldman
M
M
Mat
O
O
Estermans
G
G
Crusiaux
A
A
Vanherweghem
J L
JL
De Pauw
L
L
Kinnaert
P
P
Vereerstraeten
P
P
D000328:Adult; D006082:Graft Enhancement, Immunologic / Q000379:methods*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D016853:Muromonab-CD3 / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use*; D010865:Pilot Projects
D016853:Muromonab-CD3