Are surveillance endomyocardial biopsies necessary during OKT3 induction therapy?
BACKGROUND
To determine the utility of surveillance endomyocardial biopsies (EMBs) during a 14-day OKT3 induction course after cardiac transplantation, histologic results of the first two EMBs were retrospectively reviewed.


METHODS
Seventy-three consecutive cardiac transplant recipients who received an OKT3-based quadruple sequential immunosuppressive protocol were analyzed. Patients were predominantly white (85%) and male (72%), with ischemic cardiomyopathy (54%) and a pretransplant panel-reactive antibody level of <10% (93%).


RESULTS
The first EMB in 73 patients demonstrated no rejection in 70 patients (96%) and grade 1A rejection in 3 patients (4%). The second EMB showed no rejection in 64 patients (88%), grade 1A or 1B rejection in 8 patients (11%), and grade 3A rejection without hemodynamic compromise in only 1 patient (1%). Absolute CD3+ cells remained below 25 lymphocytes/mm3, and mean trough OKT3 serum levels exceeded 500 ng/ml throughout the 14 days of therapy, demonstrating the immunosuppressive efficacy of OKT3. Posttransplant echocardiograms showed normal left ventricular systolic function.


CONCLUSIONS
Since 145 of 146 EMBs (99%) demonstrated no or minimal allograft rejection, a large cost savings could be realized if EMBs were performed only when clinically indicated during the 14-day OKT3 induction course in cardiac transplant recipients. Appropriate immunologic monitoring and echocardiographic testing may obviate the need for performing costly EMBs during OKT3 induction without an adverse clinical outcome.
Daoud
A J
AJ
Department of Pathology, University of Cincinnati Medical Center, Ohio 45267-0714, USA.
Bhat
G
G
Schroeder
T J
TJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000592:standards; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000517:prevention & control; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015166:Monitoring, Immunologic; D016853:Muromonab-CD3 / Q000627:therapeutic use*; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate
D007166:Immunosuppressive Agents; D016853:Muromonab-CD3