Reversible sensorineural hearing loss following administration of muromonab-CD3 (OKT3) for cadaveric renal transplant immunosuppression

This prospective study is a follow-up to a case report noting reversible se nsorineural hearing loss after administration of OKT3 for immunosuppression in a steroid-resistant renal cadaveric transplant patient who was rejectin g his transplant. The objective is to determine the interval estimate for i ncidence of sensorineural hearing loss following treatment with OKT3. Seven patients were admitted to the Renal Transplant Service at Montefiore Medic al Center from July 1996 to July 1997 with steroid-resistant rejection of r enal cadaveric transplants and received OKT3 as an immunosuppressant. All 7 patients received 3 audiograms: the first, prior to the administration of the first dose of OKT3, the second, 48 to 72 hours after administration of OKT3, and the third, approximately 2 weeks after administration of OKT3. Fi ve of the 7 patients (71%) demonstrated a sensorineural hearing loss of 15 dB or greater at frequencies of 8 to 12 kHz. Four of the 5 patients with au diographic changes had near-complete to complete recovery of their high fre quency thresholds after discontinuation of the drug regimen. Ln conclusion, OKT3 can cause sensorineural hearing loss. This side effect is mainly reve rsible after 2 weeks following discontinuation of the drug. Patients receiv ing OKT3 should be forewarned of this possible side effect prior to the adm inistration of OKT3.