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[OKT 3 treatment of kidney transplant recipients]
G J Zlabinger1, W Ulrich, E Pohanka
1Institut für Immunologie, Universität Wien.
Abstract:
Anti-rejection therapy with the monoclonal antibody OKT 3 was effective in the treatment of acute rejection episodes in 66% (47/71) of OKT 3 treated kidney graft recipients. The success of OKT 3 therapy, however, appeared to be dependent on certain variables. Reversal of rejection differed significantly according to the indication, namely if patients were treated first line, as opposed to rescue therapy. Vascular components of rejection and/or severe interstitial rejection, as well as acute tubular necrosis were associated with a worse reversal rate. Non-responders to OKT 3 presented with significantly lower serum OKT 3 trough levels during the first three days of the treatment course. The presence of more than one of these risk factors was shown to decrease the reversal rate of rejection significantly. The variables appeared to exert their influence in an additive fashion. Administration of OKT 3 led to the induction of an acute phase reaction, which could be detected within one day after start of therapy. The incidence of both bacterial and viral infection was increased dramatically in OKT 3 treated patients as compared with graft recipients who were not treated with monoclonal or polyclonal antilymphocyte antibodies. The findings demonstrate that OKT 3 is of value in the treatment of acute rejection episodes but provide evidence of differential indications for OKT 3 therapy, which must be taken into account to optimize control of rejection and avoid unnecessary side effects where the drug is not indicated.
Insights
OKT 3 monoclonal antibody therapy effectively treated kidney transplant rejection in 66% of patients. However, success depended on rejection severity, treatment timing, and patient factors, influencing outcomes and infection risk.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Acute rejection episodes pose a significant threat to kidney graft survival.
- Monoclonal antibody OKT 3 is used for anti-rejection therapy.
- Predicting OKT 3 efficacy and identifying risk factors is crucial for patient management.
Purpose of the Study:
- To evaluate the effectiveness of OKT 3 in treating acute kidney graft rejection.
- To identify variables influencing OKT 3 therapy success.
- To assess the side effects associated with OKT 3 treatment.
Main Methods:
- Retrospective analysis of 71 kidney graft recipients treated with OKT 3 for acute rejection.
- Assessment of rejection reversal rates based on indication, rejection severity, and acute tubular necrosis.
- Monitoring of serum OKT 3 trough levels and incidence of infections.
Main Results:
- OKT 3 achieved successful rejection reversal in 66% of patients.
- First-line treatment and less severe rejection were associated with better outcomes.
- Lower OKT 3 trough levels and presence of risk factors (vascular rejection, severe interstitial rejection, ATN) correlated with poorer response.
- Increased incidence of bacterial and viral infections observed in OKT 3 treated patients.
Conclusions:
- OKT 3 is valuable for acute kidney rejection but its use should be guided by specific indications.
- Identifying patients at high risk for poor response can optimize treatment strategies.
- Careful consideration of potential side effects, including infection, is necessary.