LONG-TERM OUTCOME OF THE USE OF OKT3 TO TREAT STEROID-RESISTANT ACUTERENAL-ALLOGRAFT REJECTION

OKT3 was used to treat steroid-resistant acute renal allograft rejecti on in 30 of 496 adult patients transplanted over a 6-year period. Reje ction was reversed (defined as a fall in serum creatinine by 50 % or m ore within 30 days of treatment with OKT3) in 40 % of cases. Successfu l reversal was significantly more likely when rejection occurred short ly after transplantation (t ratio - 2.53; P = 0.019). The long-term ou tcome was disappointing; the actuarial graft survival at 1 year from t he start of treatment with OKT3 was 42 %, and no grafts have thus far survived longer than 3 years. Graft survival was shorter in older pati ents (coefficient/standard error 2.226; P < 0.05), and no other predic tor of long-term outcome was identified. Patient survival at 3 years w as 88 %. Serious infection occurred in 33 % of patients, with two deat hs. Our experience suggests that treatment with OKT3 is unlikely to re verse acute renal allograft rejection in more than half of patients wh ere rejection is resistant to steroids. Although long-term graft survi val occurred in a few cases, the overall long-term outcome was disappo inting, particularly in older patients. Finally, our analysis indicate s the difficulty of predicting which patients will derive long-term be nefit when OKT3 is used to treat steroid-resistant rejection.