HOW SUCCESSFUL IS OKT3 RESCUE THERAPY FOR STEROID-RESISTANT ACUTE REJECTION EPISODES AFTER HEART-TRANSPLANTATION

OKT3 is recommended as rescue therapy for cases of steroid-resistant, clinically persistant acute rejection episodes after heart transplanta tion. In this study we determined the efficacy of such treatment. One hundred thirty-two patients were included in this study. The postopera tive immunosuppressive regimen consisted of triple-drug therapy and pe rioperative antithymocyte globulin. During a follow-up of 10 to 108 we eks (mean, 51 +/- 20 weeks) 281 treatment-requiring acute rejection ep isodes (International Society for Heart and Lung Transplantation great er-than-or-equal-to II) were observed. In 29 cases (10.3%) the grade o f the acute rejection episodes was either unchanged after two series o f intravenous steroid pulse therapy, was worsened after the first ster oid course, or the patient experienced clinical deterioration as a res ult of the acute rejection episodes. These patients were considered to have steroid-resistant acute rejection episodes and received a 10-day rescue therapy with OKT3, followed by control endomyocardial biopsy. In 17 cases, control endomyocardial biopsy revealed normal myocardium (group I). In 10 cases acute rejection episodes remained unchanged (gr oup II); twice a deterioration was found (group III). However, 12 of t he 17 patients from group I experienced a rebound of the acute rejecti on episodes (International Society for Heart and Lung Transplantation greater-than-or-equal-to II) 1 to 3 weeks later. Side effects of OKT3 treatment were fever, chills, intestinal complications, hemodynamic re sponse, convulsions, and viral infections. Complete remission of stero id-resistant acute rejection episodes by OKT3 rescue therapy was there fore only achieved in five patients (17.2%), in all other cases furthe r treatment of the acute rejection episodes with methotrexate was nece ssary. As a result from this study routine OKT3 rescue therapy has bee n discontinued at our center and remains restricted to particular case s.