PMID: 2504896Jul 1, 1989Paper

Selective use of OKT3 in heart transplantation with the use of risk factor analysis

The Journal of Heart Transplantation
M P MacrisJ M Duncan

Abstract

Heart transplant patients who develop early (within 2 weeks after transplantation) severe renal dysfunction require an alternative to cyclosporine-based immunosuppressive induction therapy. In our experience, muromonab-CD3 (Orthoclone OKT3) is an excellent alternative for such patients. When compared with cyclosporine, however, it is associated with a higher incidence of infection. We conducted a retrospective analysis of a series of our patients to improve our ability to identify such patients. Selected risk factors for severe renal dysfunction included creatinine clearance less than 55 ml/min, hospitalization before transplant, perioperative cardiovascular compromise, and mechanical circulatory support. Of 50 adult patients (mean age 52 years), 35 (70%) completed full induction with intravenous (IV) cyclosporine (1 to 4 mg/kg/24 hr); 13 (26%) developed severe renal dysfunction; and two (4%) were excluded as a result of nonprotocol failures. Of the 13 patients in whom IV cyclosporine induction was precluded by severe renal dysfunction, 11 (85%) received IV OKT3 (5 mg/24 hr), and two (15%) received antithymocyte globulin (14 mg/kg/24 hr). Chi-square analysis showed perioperative cardiovascular compromise (p less than 0.001), ho...Continue Reading

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