OKT3 (muromonab-CD3) associated hepatitis in a kidney transplant recipient

The introduction of OKT3 (muromonab-CD3) revolutionized the management of steroid-resistant rejection in transplant patients. Indeed, after the success of OKT3 for treatment of rejection, some centers used OKT3 for perioperative prophylaxis against rejection after transplantation. Despite the success of this agent for prevention and treatment of rejection, its use is associated with side effects. These side effects, including the cytokine release syndrome and flash pulmonary edema, are well recognized in the transplant community. However, there have been no published reports of acute severe hepatitis associated with the use of OKT3 in non-liver transplant patients. We describe here a case of acute severe hepatitis encountered during treatment of acute renal allograft rejection with OKT3 in a 31-year-old black man.