MURINE MONOCLONAL CD3 ANTIBODY (OKT3)-BASED EARLY REJECTION PROPHYLAXIS IN PEDIATRIC HEART-TRANSPLANTATION

The purpose of this study was to review our experience with the use of OKT3 (a murine monoclonal CD3 antibody) used as immune prophylaxis fo r pediatric heart transplant recipients. Orthotopic heart transplantat ion was performed in 18 pediatric patients, 8 girls and 10 boys, rangi ng in age from 17 days to 17 years. OKT3 therapy was initiated intraop eratively at a dose of approximately 0.2 mg/kg and was administered at a dose of approximately 0.1 to 0.2 mg/day for a period of 11.5 +/- 2. 5 days. Daily average OKT3 levels were 1132 +/- 469 ng/ml. Side effect s that occurred during OKT3 therapy were fever (59%), diarrhea (24%), headaches (24%), vomiting (18%), encephalopathy (12%), pulmonary edema (6%), and rash (6%). Infections occurred in 24% of patients, all with in 6 months of transplantation. In the first year after transplantatio n, patients experienced 3.4 +/- 2.4 episodes of mild rejection and 1.0 +/- 0.8 episodes of moderate rejection. No patient experienced severe rejection. Five of the surviving 14 patients (36%) have been weaned f rom chronic steroid therapy, and 42% are being maintained on alternate -day prednisone at a dose of 0.06 +/- 0.02 mg/kg/day. Coronary artery disease developed in three patients; two of whom died. Actuarial survi val was 83% at 1 year and 73% at 2 years. This report shows that OKT3 prophylaxis in pediatric heart transplantation can be used with accept able short-term adverse side effects and overall survival.