title: Induction immunosuppression with the monoclonal antibody OKT3 after cardiac transplantation.
abstract: The routine use of monoclonal induction immunosuppression with OKT3 after orthotopic heart transplantation remains controversial. This study examined the clinical response of prophylactic monoclonal induction immunosuppression versus standard triple-drug immunosuppression in 41 patients who underwent orthotopic heart transplantation from January 1989 to December 1990 at this institution. Of these, eight received monoclonal induction immunosuppression for a period of 10 to 14 days. All patients received identical triple-drug immunosuppression with the exception of cyclosporine starting on the fifth postoperative day in those who received OKT3. At 6 months the duration of hospitalization, freedom from rejection, incidence of infection requiring hospitalization, and serum creatinine in the monoclonal induction immunosuppression and triple-drug groups were compared. It was found that the length of hospital stay in the OKT3 group was 14.3 +/- 4.5 days, compared with 14.7 +/- 4.7 days in the triple-drug group and that freedom from rejection was 66% in the OKT3 group compared with 75% in the triple-drug group. In addition, it was found that the incidence of infection was 36% in the OKT3 group compared with 38% in the triple-drug group and that serum creatinine at 6 months was 1.36 +/- 0.26 mg/dl in the OKT3 group compared with 1.45 +/- 0.73 mg/dl in the triple-drug group. Finally, patient survival at 1 year for the monoclonal induction immunosuppression group was 100% compared with 91% for the triple-drug group.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Ochsner Medical Institutions, New Orleans, Louisiana.
authors.forename: D D
authors.initials: DD
authors.lastname: Stapleton
authors.forename: H O
authors.initials: HO
authors.lastname: Ventura
authors.forename: S E
authors.initials: SE
authors.lastname: Grundtner
authors.forename: F W
authors.initials: FW
authors.lastname: Smart
authors.forename: H L
authors.initials: HL
authors.lastname: Price
authors.forename: C
authors.initials: C
authors.lastname: Van Meter
authors.forename: J L
authors.initials: JL
authors.lastname: Ochsner
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003327:Coronary Disease / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006084:Graft Rejection; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality / Q000502:physiology; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: D000305:Adrenal Cortex Hormones; D016853:Muromonab-CD3; D016572:Cyclosporine; D003404:Creatinine; D001379:Azathioprine