Two low-dose OKT3 induction regimens following renal transplantation--clinical experience at a single center.
Experience with quadruple-drug induction therapy with two regimens of low-dose OKT3 in renal transplant patients was evaluated. Group I received 5.0 mg OKT3 in the operating room and on day 1, followed by 2.5 mg/d for a total dose and duration of 40 mg and 14 d, respectively, and group II received 14 d of OKT3 2.5 mg/d (a total dose of 35 mg). Rejection episodes developed in 21% of patients: 29% of group I vs. 17% of group II. In groups I and II, the mean number of days until first rejection was 134 and 119 d, respectively, and delayed graft function was observed in 24 vs. 13% of patients, respectively. Cytokine release syndrome was noted in 95% of group I patients and in 78% of group II patients. The overall incidence of infections did not differ significantly between the two groups; however, the incidence of oral candidiasis was higher in group II (30 vs. 11% in group I, p = 0.021) and the incidence of herpes simplex virus infection was higher in group I (13 vs. 1% in group II, p = 0.015). The average length of hospital stay was 6.7 d in group I and 6.2 d in group II. The current pharmacy charge for a 2.5-mg vial of OKT3 is 28% lower for a 5.0-mg vial. Our study suggests that by using either low-dose OKT3 regimen renal transplant patients can be safely treated with shortened hospital stays, lower pharmacy costs, and without increased incidence of graft loss or patient morbidity.
Division of Nephrology, St. John Hospital and Medical Center, Detroit, MI, USA.
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Provenzano
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Tayeb
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Satmary
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Jones
D000328:Adult; D002180:Candidiasis, Oral / Q000209:etiology; D016207:Cytokines / Q000378:metabolism; D016527:Drug Costs; D005069:Evaluation Studies as Topic; D005252:Fees, Pharmaceutical; D005260:Female; D005334:Fever / Q000209:etiology; D006084:Graft Rejection / Q000209:etiology; D006261:Headache / Q000209:etiology; D006561:Herpes Simplex / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000502:physiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011292:Premedication; D013997:Time Factors
D016207:Cytokines; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3