MUROMONAB CD3 (ORTHOCLONE OKT3(R)) FOR PR OPHYLAXIS OF CARDIAC TRANSPLANT REJECTION - HEMODYNAMIC AND RESPIRATORY TOLERANCE

Objective: Treatment of transplant rejection with muromonab CD3 (Ortho clone OKT3(R)) may result in haemodynamic instability and pulmonary oe dema, which would question its prophylactic use. The aim of this study was to the evaluate haemodynamic and respiratory tolerance of prophyl actic treatment of cardiac rejection with OKT3. Study design: Prospect ive clinical study. Patients: Twelve patients, whose pulmonary arteria l resistances before transplantation were less than 400 dyn . s . cm(- 5), with haemodynamic and respiratory stability during the 4 hours bef ore OKT3 administration. Method: Patients under preventive haemodynami c support with isoprenaline 0.05 mu g . kg(-1). min(-1) and dopamine 3 mu g . kg(-1). min(-1). Immunosuppressive treatment with azathioprine 5 mg . kg(-1) at d0 and 3 mg . kg(-1) at d1 and d2 and with methylpre dnisolone 720 mg at d0 and 240 mg at d1 and d2. OKT3, 5 mg administere d i.v. at d0, d1, d2. Respiratory and haemodynamic variables were reco rded prior to (T0), 30 min (T1) and 360 min (T2) after injection of OK T3.Result: Neither clinical nor radiological changes were observed aft er the OKT3 injections. At d0, T2, the heart rate increased and PaO2 a nd SaO(2) decreased. At d1 and d2, T1, PaO2 decreased, and QS/QT at T1 d2 increased by nearly 3%.Conclusion: OKT3 does not result in major c irculatory and haematosis changes, provided patients are selected, esp ecially free of pretransplantation pulmonary hypertension. Prior to th e treatment with OKT3, they should be in a satisfactory haemodynamic a nd respiratory status and receive high doses of corticosteroids.