OKT3 FOR INDUCTION OF IMMUNOSUPPRESSION IN RENAL-TRANSPLANTATION

A review of the literature on the use of OKT3 for induction of immunosuppression indicates that this drug presents distinct advantages in renal transplantation. In clinical trials comparing OKT3 to cyclosporine in triple-drug regimens including azathioprine and steroids, OKT3 was associated with a significantly lower number of rejection episodes per patient, a longer time to rejection, and a trend toward improved graft survival. In addition, several high-risk recipient subgroups experienced significant and clinically meaningful improvement (5% to 10%) in 1-year graft survival with induction regimens that included OKT3 or ALG as compared to conventional therapy. These subgroups included retransplanted, sensitized, and diabetic patients, as well as those with delayed graft function or HLA-DR mismatches. In the majority of clinical trials of quadruple-therapy induction, OKT3 or polyclonal antilymphocyte antibodies in conjunction with azathioprine, steroids, and cyclosporine led to similar graft survival and numbers of patients with rejection episodes. The frequency of infection, however, varied considerably from study to study, and differences between treatments were not consistent. Although OKT3 antibodies have been reported to occur in 3% to 45% of adult patients after an initial course (10 to 14 days) of therapy, successful re-use of OKT3 has been demonstrated in patients with low antibody titers. Experience with OKT3 for induction of immunosuppression in renal allograft recipients confirms its efficacy in this role.