Use of OKT3 monoclonal antibody as induction therapy for control of rejection in liver transplantation

Abstract

This report details a single center's experience with OKT3 induction immunosuppression for liver transplantation. One hundred ninety-nine consecutive, unselected adult liver recipients received OKT3 therapy for 9-10 days combined with low-dose steroids and azathioprine. Cyclosporine was begun to overlap with the last few days of OKT3 therapy. The average dose of OKT3 was 45 mg. Fifty-two patients (26.1%) experienced 57 episodes of acute rejection. The median time of onset of rejection was 18 days after grafting. Seventy-eight percent of the rejection episodes were steroid-sensitive. Recurrent rejection was uncommon and the need for OKT3 retreatment was infrequent. One year actuarial graft and patient survival was 79.7% and 82.3% respectively. Based on this evidence, it appears that OKT3 prophylaxis provides good control of acute rejection with a very low incidence of recurrent rejection.

Biliary reconstruction without T tubes or stents in liver transplantation: Report of 502 consecutive cases

“…Induction immunosuppression was usually with either OKT3 or antilymphocyte globulin. 16,17 Maintenance immunosuppression was cyclosporine in combination with steroids and/or azathioprine in the majority of patients.…”

Biliary reconstruction without T tubes or stents in liver transplantation: Report of 502 consecutive cases

“…16,17 Maintenance immunosuppression was cyclosporine in combination with steroids and/or azathioprine in the majority of patients.…”

Liver transplantation: Current status and novel approaches to liver replacement

“…14 -16 Another advance in immunosuppression was the development of antilymphocyte antibody therapy, including the monoclonal antibody muromonab-CD3, which has been used as part of induction regimens to reduce the incidence and severity of acute allograft rejection and to treat steroid-resistant acute rejection. [17][18][19] Antibody therapy is occasionally used without cyclosporine or tacrolimus for induction of immunosuppression in the setting of renal insufficiency. After its licensure, muromonab-CD3 initially replaced the earlier antilymphocyte and antithymocyte globulin preparations that could never be standardized, but the availability of newer, alternative agents and the risk of Epstein-Barr virus infection, cytomegalovirus infection, and posttransplant lymphoproliferative disease associated with the use of muromonab-CD3 have led to less usage of this agent in recent years.…”