24 heart transplant recipients were treated with OKT3 together with azathioprine for 7 days as a rejection prophylaxis. The plasma OKT3 concentration ranged from 280 to 1600 ng/ml. During treatment the T cells in peripheral blood disappeared but returned modulated without TcR‐α/β‐chains and with low CD3 expression. Antimurine antibodies were induced and median IgG antimurine antibody concentrations increased from 9.6 mg/l pretransplant to 52.1 mg/l as measured by ELISA. In 13 out of 24 patients, anti‐idiotypic antibodies were present at a level that caused over 50% inhibition of OKT3 binding to T cells. The extent of inhibition was positively correlated with the increase in IgG antimurine antibody levels, both in relative (> 3 times pre‐transplant level, p < 0.05) and in absolute terms (more than 50 mg/l, p < 0.001). In 9 patients, who received two prophylactic courses of OKT3, we found a decrease in anti‐OKT3 antibody levels after the second course of OKT3 which can be caused by the additional cyclosporin A (CsA) immune suppression. The second course also resulted in a rapid depletion of circulating functional T cells despite the presence of anti‐OKT3 antibodies generated after the first course.