EFFECT OF OKT3 IN STEROID-RESISTANT RENAL-TRANSPLANT REJECTION

Between January 1, 1982, and November 1, 1986, 169 cadaver renal graft transplantations were performed at this hospital with CsA as inductio n therapy. OKT3 was not available in this period. Of these grafts, 15. 9% were lost within 6 months, 10.7% from acute rejection (AR). Between November 1, 1986, and October 1, 1992, 483 cadaver renal graft transp lantation were performed. Induction therapy included CsA and OKT3 was available. Of these grafts, 8.7% were lost inside 6 months, 3.1% from AR. Of these last 483 grafts, 113 received 125 courses of OKT3. Ten co urses were prophylactic, and 115 courses in 103 patients were for reje ction resistant to steroid therapy (biopsy proven in all but 2 cases. Ninety-three percent of rejection episodes treated with OKT3 responded , at least initially. Graft survival in OKT3-treated patients was 81%, 77%, and 76% at 6 months, 1 year, and 2 years, respectively. In contr ast, graft survival in steroid-resistant rejection during the first pe riod (without OKT3) was 59%, 57%, and 57% at these intervals. There we re 8 infective deaths within 6 months in the 113 OKTS-treated patients , compared with 2 in the 343 who did not receive OKT3 (P<0.001). There were 7 viral deaths in the OKT3 group compared with none in those not receiving OKT3 (P<0.001). Prophylaxis with oral acyclovir and cotrimo xazole was instituted in October 1990 in OKT3-treated patients and gan ciclovir use was increased. Since this change, no further viral deaths have occurred. OKT3 is a very effective antirejection agent, but its use is associated with an increased mortality from viral infections. W ith appropriate prophylaxis and treatment, however, this mortality can be reduced.