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Rejection prophylaxis with sequential OKT3 and CSA after kidney transplantation
W Weimar1, C J Hesse, L M Vaessen
1Department of Internal Medicine I, University Hospital Rotterdam, The Netherlands.
Biotherapy (Dordrecht, Netherlands)
|January 1, 1990
Summary
This study shows that OKT3 antibody combined with azathioprine effectively prevents kidney transplant rejection, leading to excellent patient and graft survival. Beneficial effects of this immunosuppression protocol outweigh the observed side effects.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Kidney transplant rejection remains a significant challenge.
- Optimizing early immunosuppression is crucial for graft survival.
- Minimizing calcineurin inhibitor-associated nephrotoxicity is a key goal.
Purpose of the Study:
- To evaluate the efficacy and safety of a novel immunosuppression protocol using OKT3 and azathioprine for kidney transplant recipients.
- To assess the impact of this protocol on patient and graft survival, and rejection rates.
- To investigate the prevention of early cyclosporine A-associated nephrotoxicity.
Main Methods:
- Sixteen kidney transplant recipients received OKT3 and azathioprine for two weeks post-transplant.
- Low-dose steroids were administered concomitantly.
- Cyclosporine A therapy was initiated on postoperative day 12.
Main Results:
- The protocol achieved 100% patient and graft survival at 18 months.
- 81% actuarial freedom from rejection was observed.
- OKT3 induced T cell modulation, with anti-OKT3 antibodies detected in 50% of patients.
- Fever, bronchospasm, hypotension, and diarrhea were noted side effects.
- The protocol successfully prevented early cyclosporine A-associated nephrotoxicity.
Conclusions:
- The combination of OKT3 and azathioprine is a highly effective prophylactic regimen against kidney transplant rejection.
- This immunosuppression strategy offers significant benefits, including superior graft survival and prevention of early nephrotoxicity.
- The observed side effects of OKT3 were manageable and outweighed by the protocol's positive outcomes.