EVALUATION OF OKT3 MONOCLONAL-ANTIBODY AND ANTI-THYMOCYTE GLOBULIN INTHE TREATMENT OF STEROID-RESISTANT ACUTE ALLOGRAFT-REJECTION IN PEDIATRIC RENAL-TRANSPLANTS

We reviewed the effectiveness of Muromonab-CD3 (OKT3) and anti-thymocy te globulin (ATG) in the treatment of corticosteroid-resistant acute r enal allograft rejection in 49 transplanted children. Reversal of reje ction was successful in 22 of 23 patients (96%) treated with OKT3 and 21 of 26 (81%) treated with ATG (P = NS). Re-rejection episodes occurr ed within 1 month of cessation of therapy in 9 of 22 patients treated with OKT3 but only in 2 of 21 who received ATG (P <0.05). In the patie nts with re-rejection, 7 of the 9 patients originally given OKT3 and 1 of the 2 who received ATG responded to a repeat course of high-dose c orticosteroids; thus, at 1 month post treatment, the incidence of graf t loss due to initial rejection or re-rejection was 13% for the OKT3 a nd 23% for the ATG group (P = NS). Graft survival was similar at 6 mon ths: 82% for OKT3- and 73% for ATG-treated patients (P = NS); 100% pat ient survival was noted in both groups. Mean calculated creatinine cle arance prior to, during, and at 1 and 6 months post rejection was simi lar in the OKT3- and ATG-treated groups. Neutropenia and thrombocytope nia occurred more frequently in the ATG group, but there was no signif icant difference in infectious complications. Two patients developed h igh (greater-than-or-equal-to 1:1,000) OKT3 antibody titers. In our ex perience, children with corticosteroid-resistant acute renal allograft rejection treated with OKT3 and ATG had similar allograft survival an d level of renal function at 1 and 6 months, and number of infectious complications post therapy.