Evaluation of OKT3 monoclonal antibody and anti-thymocyte globulin in the treatment of steroid-resistant acute allograft rejection in pediatric renal transplants.
We reviewed the effectiveness of Muromonab-CD3 (OKT3) and anti-thymocyte globulin (ATG) in the treatment of corticosteroid-resistant acute renal allograft rejection in 49 transplanted children. Reversal of rejection was successful in 22 of 23 patients (96%) treated with OKT3 and 21 of 26 (81%) treated with ATG (P = NS). Re-rejection episodes occurred within 1 month of cessation of therapy in 9 of 22 patients treated with OKT3 but only in 2 of 21 who received ATG (P < 0.05). In the patients with re-rejection, 7 of the 9 patients originally given OKT3 and 1 of the 2 who received ATG responded to a repeat course of high-dose corticosteroids; thus, at 1 month post treatment, the incidence of graft loss due to initial rejection or re-rejection was 13% for the OKT3 and 23% for the ATG group (P = NS). Graft survival was similar at 6 months: 82% for OKT3- and 73% for ATG-treated patients (P = NS); 100% patient survival was noted in both groups. Mean calculated creatinine clearance prior to, during, and at 1 and 6 months post rejection was similar in the OKT3- and ATG-treated groups. Neutropenia and thrombocytopenia occurred more frequently in the ATG group, but there was no significant difference in infectious complications. Two patients developed high (> or = 1:1,000) OKT3 antibody titers. In our experience, children with corticosteroid-resistant acute renal allograft rejection treated with OKT3 and ATG had similar allograft survival and level of renal function at 1 and 6 months, and number of infectious complications post therapy.
Department of Pediatrics, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA 19134-1095.
M
M
Mochon
B
B
Kaiser
J A
JA
Palmer
M
M
Polinsky
J T
JT
Flynn
G C
GC
Caputo
H J
HJ
Baluarte
D000208:Acute Disease; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D004351:Drug Resistance; D005069:Evaluation Studies as Topic; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D016853:Muromonab-CD3 / Q000009:adverse effects / Q000627:therapeutic use*; D009503:Neutropenia / Q000139:chemically induced; D011241:Prednisone / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced; D014184:Transplantation, Homologous
D000961:Antilymphocyte Serum; D016853:Muromonab-CD3; D011241:Prednisone