OKT3 prophylaxis in renal grafts with prolonged cold ischemia times: association with improvement in long-term survival.
The data on patients participating in two randomized, prospective studies with similar immunosuppressive regimens were updated and combined to evaluate the long-term effects of OKT3 according to cold ischemia time (< or = or > 24 hr). Among 159 patients in the OKT3 and 153 in the cyclosporine A (CsA) group, 8 and 12 deaths occurred, respectively (P = NS). In patients with cold ischemia > 24 hours, OKT3 prophylaxis resulted in a lower mean number of rejection episodes per patient than did CsA prophylaxis within one year (mean +/- SEM: 0.87 +/- 0.11 vs. 1.35 +/- 0.14, respectively; P = 0.008) and within five years (1.07 +/- 0.12 vs. 1.49 +/- 0.15, respectively; P = 0.032). In contrast, rejection incidences in patients with cold ischemia < or = 24 hours was not significantly different in the two groups. In all study patients, there was a trend towards higher graft survival rates in the OKT3 group versus the CsA group (at 5 years, 73% vs. 66%, respectively; P = 0.182). Among recipients of kidneys with cold ischemia times > 24 hours, OKT3 patients had significantly higher graft survival than CsA patients at two years (84% vs. 64%, respectively) and at five years (71% vs. 56%, respectively; P = 0.045). Significant differences were not observed in recipients of kidneys with cold ischemia times < or = 24 hours. In conclusion, patients receiving renal grafts with long cold ischemia times strongly benefit from OKT3 prophylaxis.
Abramowicz
D
D
Department of Nephrology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Belgium.
Norman
D J
DJ
Vereerstraeten
P
P
Goldman
M
M
De Pauw
L
L
Vanherweghem
J L
JL
Kinnaert
P
P
Kahana
L
L
Stuart
F P
FP
Thistlethwaite
J R
JR
Shield
C F
CF
Monaco
A
A
Wu
S C
SC
Haverty
T P
TP
D000328:Adult; D003080:Cold Temperature; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007511:Ischemia; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D016853:Muromonab-CD3 / Q000627:therapeutic use*; D009926:Organ Preservation / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors
D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D016572:Cyclosporine