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Induction of thromboses within renal grafts by high-dose prophylactic OKT3

D Abramowicz1, O Pradier, A Marchant

  • 1Department of Nephrology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Belgium.

Lancet (London, England)
|March 28, 1992
PubMed

Insights

Prophylactic OKT3 in kidney transplant patients led to intragraft thromboses in 9% of recipients. This study confirms OKT3

Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Hematology

Background:

  • Kidney transplantation is a vital treatment for end-stage renal disease.
  • Prophylactic immunosuppression is crucial to prevent graft rejection.
  • OKT3 (muromonab-CD3) is a potent immunosuppressive antibody.

Purpose of the Study:

  • To investigate the incidence and nature of intragraft thromboses in kidney transplant recipients receiving prophylactic OKT3.
  • To determine if OKT3 administration is associated with procoagulant effects.

Main Methods:

  • Retrospective analysis of 93 kidney transplant patients receiving prophylactic OKT3 (10 mg/day for 2 weeks).
  • Clinical assessment for intragraft thromboses within 2 weeks post-transplantation.
  • Measurement of plasma prothrombin fragment 1 and 2 levels 4 hours after the first OKT3 dose.

Main Results:

  • Nine out of 93 patients (9.7%) developed intragraft thromboses within 2 weeks.
  • Thrombotic events included graft artery (1), graft veins (3), and glomerular capillaries with thrombotic microangiopathy (5).
  • Elevated plasma prothrombin fragment 1 and 2 levels were observed in OKT3 recipients compared to controls, indicating procoagulant activity.

Conclusions:

  • Prophylactic OKT3 administration is associated with a significant risk of intragraft thromboses in kidney transplant recipients.
  • OKT3 exhibits in vivo procoagulant effects, contributing to thrombotic complications.
  • These findings necessitate careful consideration of OKT3 use and potential thrombotic risk management strategies.

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