Anti-OKT3 response following prophylactic treatment in paediatric kidney transplant recipients.
The anti-OKT3 response was studied in 40 paediatric kidney transplant recipients receiving OTK3 as a prophylactic treatment in association with azathioprine and prednisone. Only 1 patient experienced a reversible acute rejection episode while receiving OKT3. OKT3 induced a rapid disappearance of CD3+ cells, but significant proportions of CD3+ cells reappeared before the end of the treatment in 14 patients. Wide variations in circulating OKT3 levels were observed and in only 50% of patients could stable circulating OKT3 levels be detected until discontinuation of treatment. Anti-OKT3 antibodies detected by the enzyme-linked immunosorbent assay (ELISA) (anti-idiotypic and anti-isotypic antibodies) developed in 91% of patients. Anti-idiotypic antibodies detected by the immunofluorescence inhibition test were found in the sera of 71% of patients, always when high titres of anti-OKT3 antibodies were detected by ELISA. As it has recently been shown that anti-idiotypic antibodies are associated with failure of subsequent OKT3 treatment, we conclude that OKT3 should be restricted to steroid-resistant rejection crises in paediatric patients.
Paediatric Nephrology Unit, Hôpital Necker-Enfants-Malades, France.
P
P
Niaudet
G
G
Jean
M
M
Broyer
L
L
Chatenoud
D000293:Adolescent; D000888:Antibodies, Anti-Idiotypic / Q000096:biosynthesis*; D001379:Azathioprine / Q000627:therapeutic use; D017252:CD3 Complex / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005455:Fluorescent Antibody Technique; D006084:Graft Rejection / Q000628:therapy; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007132:Immunoglobulin Isotypes / Q000276:immunology; D016030:Kidney Transplantation / Q000276:immunology*; D007683:Kidney Tubular Necrosis, Acute / Q000276:immunology; D008297:Male; D016853:Muromonab-CD3 / Q000276:immunology* / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011292:Premedication
D000888:Antibodies, Anti-Idiotypic; D017252:CD3 Complex; D007132:Immunoglobulin Isotypes; D016853:Muromonab-CD3; D001379:Azathioprine; D011241:Prednisone