OKT3 FOR THE TREATMENT OF STEROID-RESISTANT ACUTE RENAL-ALLOGRAFT REJECTION

OKT3 (Orthoclone) was first used in this unit on February 25, 1987. Up until March 31, 1996, 153 patients had a total of 163 transplants. Fi fty of these patients who received 53 transplants (28 male, mean age 3 7.5 years, 48 cadaveric donors), were treated with OKT3 for steroid-re sistant acute rejection. Forty-nine graft biopsies were undertaken and 47 showed acute rejection. In the other 4 episodes a clear-cut clinic al and laboratory diagnosis of severe rejection was made. OKT3 (5 mg i .v.) was started at a median of 19 days following transplantation and was successful in reversing 43 of 51 (84%) episodes of steroid-resista nt acute rejection. Of those treated, the patient and graft survival a t 1 year was 86 and 69%, at 3 years 82 and 64% and at 5 years 79 and 6 1%, respectively. Adverse effects were common. Four patients died from sepsis within the first 3 months after transplantation. OKT3 was effe ctive in reversing 84% of steroid-resistant acute rejection episodes.