Use of a Brief Steroid Trial Before Initiating OKT3 Therapy for Renal Allograft Rejection

J. Richard Thistlethwaite, Joan K. Stuart, James T. Mayes, A. Osama Gaber, Frank P. Stuart

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

OKT3 (Ortho Pharmaceutical, Raritan, NJ) has been employed in a protocol where all patients received cyclosporine as part of their baseline immunosuppressive regimen and, after the diagnosis of rejection was established, were treated with up to three pulses of methylprednisolone before monoclonal antibody therapy was initiated. Use of this protocol has allowed 46% of rejection episodes encountered to be treated on an outpatient basis without resorting to inpatient use of OKT3, but has avoided delaying OKT3 therapy until after all other methods of rejection treatment were found to be ineffective. Of 83 rejection episodes treated with OKT3 between March 1985 and May 1987, 78 (94%) were reversed. Overall graft survival is 84% and patient survival is 96% in OKT3-treated patients. Of the 17 rejection episodes where OKT3 treatment was a second or third exposure to the drug, rejection was successfully reversed in 15 (88%). In cadavar donor allograft recipients transplanted between March 1985 and May 1986, actual 1-year graft survival is 80% for 30 patients requiring no rejection therapy, 80% for 20 patients with rejection episodes responding quickly to steroids, and 82% for 28 patients with OKT3-treated, steroid-insensitive rejections. Mean serum creatinine at 1 year posttransplant is 1.5 ± 0.5; 1.9 ± 0.7; and 2.1 ± 0.8, respectively, for these groups of patients. Thus, for patients maintained on baseline cyclosporine: (1) initial treatment of a renal allograft rejection episode with up to three daily steroid pulses often spares the use of the potent immunosuppressant OKT3; (2) when a rapid response to steroids is not observed, prompt use of OKT3 reverses rejection effectively; and (3) actual 1-year graft survival and function in OKT3-treated patients are as good as in renal allograft recipients not requiring OKT3 for rejection therapy.

Original languageEnglish (US)
Pages (from-to)94-98
Number of pages5
JournalAmerican Journal of Kidney Diseases
Volume11
Issue number2
DOIs
StatePublished - Jan 1 1988

Keywords

  • OKT3
  • Transplantation
  • allograft rejection
  • kidney
  • monoclonal antibody

ASJC Scopus subject areas

  • Nephrology

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