| Autor: |
McDiarmid, Sue V., Millis, Michael J., Terasaki, Paul, Vargas, Jorge H., Ament, Marvin E., Busuttil, Ronald W. |
| Zdroj: |
Clinical Transplantation; Part 16/April 1991, Vol. 5 Issue: 2 p174-180, 7p |
| Abstrakt: |
This report reviews our experience with prophylactic OKT3 in pediatric liver transplantation, induction protocols in use elsewhere, and future new alternatives. In a randomized prospective study we have compared induction with OKT3, steroids and azathioprine to conventional therapy with cyclosporine, steroids and azathioprine. Twelve children were in the OKT3 prophylaxis group and 8 in the cyclosporine group. In the first 14 days patients in the OKT3 group had significantly less rejection (25%) compared to the cyclosporine group (75%). A high incidence of rebound rejection (33%) was seen in the OKT3 group so that overall there was no difference in rejection incidence between the two groups (83% in OKT3 group, 87% in cyclosporine group). The OKT3 group did not have an increased risk of infection. Long‐term follow‐up showed no difference in graft or patient survival, renal function, or the late occurrence of rejection or infection. On recommended doses of OKT3, 45% of children were unable to maintain CD3+ cells less than 5%. Sixty‐seven percent of children developed anti‐OKT3 antibodies after prophylaxis, usually of low titer. OKT3 was re‐used after prophylaxis for treatment of 7 rejection episodes. Two‐thirds of these patients developed CD3+ cells greater than 60%. Two episodes completely resolved and 3 partially responded. Compared to adults in the same study, pediatric recipients had more rejection requiring OKT3 rescue, a higher incidence of increased CD3+ cells during OKT3 use, and developed anti‐OKT3 antibodies more often. Pediatric patients require careful monitoring during OKT3 use and may require higher doses than currently used. As OKT3 prophylaxis offered no long‐term benefits, we reserve its use for treatment of steroid‐resistant rejection. OKT3 prophylaxis is indicated in carefully selected patients in whom intravenous cyclosporine is contraindicated. |
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