TREATMENT AND PREVENTION OF LIVER ALLOGRAFT-REJECTION WITH OKT3

Over the past several years, OKT3 therapy has compared well with existing regimens in the treatment and prevention of acute hepatic allograft rejection. When used as first-line treatment for rejection, OKT3 was shown to be as effective as corticosteroids in reversing the rejection process, particularly in adults. As second-line therapy for acute rejection, preceded in most studies with only one or two boluses of corticosteroids, OKT3 appeared effective in reversing the clinical picture of rejection. In two of three randomized controlled studies, OKT3 induction therapy with azathioprine and steroids preserved renal function during the first 14 days after transplantation and was associated with significantly fewer acute rejection episodes than was cyclosporine in standard triple-drug therapy. Adverse reactions following OKT3 administration are similar to those reported in renal allograft recipients and are largely mild and well-tolerated although a few patients may experience anaphylactic reactions that hamper further OKT3 use. Whether OKT3 induction or rescue therapy increases the risk of infection when compared to other immunosuppressants remains the subject of continued investigation. Some studies associate OKT3 induction with a higher incidence of major infection than that observed with OKT3 rescue therapy. CMV infection prophylaxis is advisable in patients receiving OKT3. OKT3 therapy seems particularly suitable in liver transplant patients with: 1) hepatorenal syndrome; 2) posttransplantation renal insufficiency; 3) acute cyclosporine toxicity; and 4) steroid-resistant acute rejection.