OKT3 TREATMENT OF CARDIAC ALLOGRAFT-REJECTION

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.