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.
Oh
H K
HK
Division of Nephrology, St. John Hospital and Medical Center, Detroit, MI, USA.
Provenzano
R
R
Tayeb
J
J
Satmary
N
N
Jones
B
B
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