[Pulmonary complications from monoclonal antibody (OKT3) immunosuppression in patients who have undergone an orthotopic liver transplant].
The authors investigated the incidence of pulmonary complications following immunosuppression with monoclonal antibodies (OKT3) in a series of 100 consecutive cases of orthotopic liver transplantation (OLT). Of 17 patients treated with OKT3 (16 for acute rejection and 1 for cyclosporine toxicity), 11 pulmonary infections were observed (65%), 9 of which (53%) with onset within a mean of 9 days after OKT3 administration. The infections were severe in all cases and lethal in 8 cases: the most common pathogens were Candida (4 cases) and Pseudomonas aeruginosa (3 cases). On the contrary, of 39 cases of rejection treated with steroids, infections were observed in 3 cases only (8%). The 53% incidence of pulmonary infections in OKT3 patients, significantly higher than in the extant patients (19%), confirms OKT3 treatment as a strong risk factor for severe pulmonary infections. Furthermore, the occurrence of pulmonary edema was directly related to OKT3 administration in 7 OKT3 patients (41%), whereas only 20 cases (24%) occurred in the extant OLT patients (p < 0.001). OKT3-related pulmonary edema was always observed in hyperhydrated patients at the time of drug administration and it seemed to be related to the vasoactive myocardiotoxic agents released by damaged T-cells.
Golfieri
R
R
Istituto di Radiologia, II Cattedra, Policlinico S. Orsalo, Bologna.
Giampalma
E
E
Lalli
A
A
Sama
C
C
Venturoli
N
N
Mazziotti
A
A
Gozzetti
G
G
Gavelli
G
G
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000008:administration & dosage / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011654:Pulmonary Edema / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies
D016853:Muromonab-CD3
Complicanze polmonari da immunosoppressione con anticorpi monoclonali (OKT3) nei pazienti sottoposti a trapianto ortotopico di fegato.