OKT3 Therapy in Addition to Tacrolimus Is Associated with Improved Long-Term Function in Patients with Steroid Refractory Renal Allograft Rejection

Abstract

Background/Aims: The aim of this study was to evaluate long-term allograft salvage rates of patients with steroid refractory allograft rejection after kidney transplantation and to identify factors indicating a successful outcome. Patients and Methods: Fifty patients with continuing rejection after high-dose steroids were included in the study. Baseline immunosuppression was switched from cyclosporine to tacrolimus in all patients. Twenty patients additionally received OKT3 as antirejection therapy. Patients having received a cadaveric renal transplant in 1995, excluding patients with steroid resistant rejection, were chosen as a control cohort. Results: Patient survival rates were 96% (n = 48) and 90% (n = 45) and allograft survival rates were 66% (n = 33) and 62% (n = 31) after 5 and 7 years following steroid refractory renal allograft rejection. Graft survival within the control cohort was 73% after 5 years and 69% after 7 years. Creatinine clearance increased from 20 ± 15 ml/min/1.73 m² at the start of tacrolimus therapy to 37 ± 29 ml/min/1.73 m² and to 32 ± 26 ml/min/1.73 m² after 5 and 7 years. OKT3 treatment predicted successful rescue therapy (p = 0.005 and p = 0.04 after 5 and 7 years). Conclusion: Our data indicate a reasonable graft survival in steroid refractory renal allograft rejection using tacrolimus. OKT3 treatment in addition to tacrolimus therapy may be beneficial for long-term allograft survival.

Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

“…This has proved to be particularly useful in cases of acute kidney rejection whilst minimizing risk levels. Further advances have also been made with the employment of monoclonal antibodies and OKT3 against the lymphocytes of transplant recipients [ 130 , 131 ]. At present, though, the application of immunoglobulin is most prevalent as a means of inducing immunosuppression, as well as being used to overcome acute rejection and to reduce the prevalence of alloantibodies as part of the desensitization process.…”

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

“…When acute rejection does not respond to first‐line treatment with steroids, additional treatment (e.g. with a lymphocyte‐depleting antibody) may be successful (105,165). Alternatively, a failure of function to return to baseline could be due to a new pathological process, such as coexistent acute tubular necrosis, drug toxicity or BKV nephropathy, that would require a different treatment approach.…”

Evolution of Immunosuppressive Agents in Renal Transplantation: An Updated Review

“…OKT3 together with tacrolimus, MMF and prednisolone improved the graft survival and renal function in patients with steroid-resistant rejection [161]. Low doses OKT3 and low dose ATG were found to be equally effective in the treatment of steroid-resistant rejection [162]. However, the use of OKT3 in RT has been abandoned due to its severe side-effects and the availability of safer agents.…”