Prophylactic use of OKT3 in immunologic high-risk cadaver renal transplant recipients

Prophylactic OKT3 was administered to 27 immunologic high-risk cadaver renal transplant recipients (multiple transplant and/or panel reactive antibody greater than 50%) as part of a sequential immunosuppressive protocol consisting of OKT3, prednisone, azathioprine, and cyclosporine. The first dose of OKT3 was administered intraoperatively. Patient survival was 100% with a mean follow-up period of 13 months. Graft survival at 1 year was 70% (19 of 27). Eight grafts were lost during the first 6 weeks. Causes of graft loss were hyperacute rejection or primary nonfunction (4), irreversible rejection (2), and technical (2). After the first month, single rejection episodes occurred in four patients and multiple rejection episodes in three patients; all were successfully reversed, and no further graft losses were encountered. Mean serum creatinine level at 1 month posttransplant was 141 mumol/L (1.6 mg/dL), and the average serum creatinine has remained at that level during the follow-up period. No serious infections were encountered. Prophylactic OKT3 administration resulted in depletion of CD3+ lymphocytes from the peripheral circulation throughout therapy, as well as the development of therapeutic serum OKT3 levels. Five of the 27 (22%) patients developed antimurine antibodies during or after OKT3 therapy; four of these patients had low-titer antimurine antibody, and one had high-titer antimurine antibody. First-dose reactions were generally mild in this group of patients. Prophylactic use of OKT3 in this patient population resulted in superior graft survival when compared with a similar group of patients not receiving OKT3.