OKT3 salvage therapy in a quadruple immunosuppressive protocol in cadaveric renal transplantation

Transplantation
A M D'AlessandroF O Belzer

Abstract

Since the introduction of OKT3 at our center in January 1986, we have performed 246 cadaveric renal transplants (220 primary, 26 nonprimary). All patients received quadruple immunosuppression consisting of prednisone, azathioprine, and the sequential use of Minnesota antilymphoblast globulin (MALG) and cyclosporine. OKT3 (Orthoclone OKT3) therapy was reserved for corticosteroid- and/or ALG-resistant rejection. Of the 246 patients, 138 developed one or more rejection episodes (56.1%). Ninety-seven (70.3%) were successfully reversed with prednisone and/or ALG, whereas 41 (29.7%) required additional treatment with OKT3. Initial graft salvage occurred in 34 (82.9%) patients treated with OKT3, but rejection recurred in 18 (52.9%) and was successfully reversed in only 6 patients. However, the rate of recurrent rejection was much lower in patients given OKT3 early (14%), shortly after it was apparent that high-dose corticosteroid therapy was proving ineffective, than in patients who received OKT3 after a prolonged or second course of corticosteroids (64%) or ALG (60%). Graft survival after a mean follow-up interval of 11 months in all OKT3-treated patients was 54%. One or more infections occurred in 19 (46%) patients treated with OKT3...Continue Reading

Citations

Jul 1, 1994·Transplant International : Official Journal of the European Society for Organ Transplantation·P A RoweJ D Briggs
Sep 1, 1992·Transplant International : Official Journal of the European Society for Organ Transplantation·K J Parlevliet, P T Schellekens
Mar 5, 2010·BioDrugs : Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy·Sabino CiavarellaFranco Silvestris
May 1, 1992·Digestive Diseases and Sciences·R J StrattaT J Pillen
Jan 1, 1991·Progress in Cardiovascular Diseases·L W Miller
Sep 1, 1996·Journal of Transplant Coordination : Official Publication of the North American Transplant Coordinators Organization (NATCO)·S L Smith
Aug 3, 1992·The Medical Journal of Australia·G R Russ

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