Use of low-dose OKT3 as induction therapy in liver transplantation.
BACKGROUND
A pilot study was performed to prospectively evaluate the safety and efficacy of "low-dose" OKT3 induction after liver transplantation.


METHODS
Sixteen patients received a 5- to 10-day course of OKT3 (2.5 mg i.v. daily) along with azathioprine, prednisone, and the delayed introduction of cyclosporine (Neoral).


RESULTS
Patient and graft survival rates at 1 year were 88% and 82%. Five patients (31%) had biopsy-proven rejection; all five were treated successfully with steroids. There were 15 infections in 12 patients, including 5 cytomegalovirus infections. Adverse events attributed to OKT3 consisted of low-grade fever (five patients), transient hypoxemia (three patients), and transient hypotension (two patients). Pharmacy acquisition costs for OKT3 averaged $2,139 less as compared to a group of historical controls receiving full-dose therapy.


CONCLUSIONS
Low-dose OKT3 induction appears to be a safe and useful method of postoperative immunosuppression after liver transplantation. Its ultimate clinical, immunologic, and economic efficacy awaits determination by randomized trial.
Whiting
J F
JF
Department of Surgery, University of Cincinnati Medical Center, Ohio 45267-0558, USA. whitinjf@healthall.com
Fecteau
A
A
Martin
J
J
Bejarano
P A
PA
Hanto
D W
DW
D000328:Adult; D000704:Analysis of Variance; D001379:Azathioprine / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D016853:Muromonab-CD3 / Q000008:administration & dosage / Q000009:adverse effects*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D011241:Prednisone / Q000627:therapeutic use; D015996:Survival Rate
D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D016572:Cyclosporine; D001379:Azathioprine; D011241:Prednisone