Since the initial report of the murine monoclonal antibody OKT3 for ac
ute kidney rejection, a significant body of information has been colle
cted regarding the efficacy of OKT3 in reversing acute allograft rejec
tions in kidney, liver, and heart transplant recipients. The use of OK
T3 therapy for the reversal of cardiac allograft rejection in patients
in whom other therapeutic alternatives have failed or are contraindic
ated is described. Treatment with OKT3 reversed acute heart rejection
in 102 of 113 patients (90%). Complete reversal was achieved in 63 pat
ients, and partial reversal in 39 patients. At 2 years, graft and pati
ent survival rate was 77% and 65%, respectively. No significant differ
ences were noted in reversal rate and in 12-month graft and patient su
rvival rates between those patients experiencing one rejection episode
and those patients experiencing two or more rejection episodes. Compa
rable reversal rates and graft and patient survival rates were achieve
d in patients whether OKT3 was administered as the primary rejection t
herapy or as rescue therapy. Adverse events were common in the first 2
days of therapy, but they were well tolerated in most patients. Infec
tious complications occurred in 49% of patients in whom most infection
s were not serious. On the basis of this experience, OKT3 appears high
ly effective in reversing acute cardiac allograft rejection.