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Published on: November 7, 2020
Renal-sparing immunosuppressive protocol using OKT3 after liver transplantation: a 19-year single-institution
Peter T W Kim1, Srinath Chinnakotla, Gary Davis
1Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas. Dr. Kim is now a hepatobiliary fellow in Canada.
Abstract:
Different renal-sparing immunosuppressive protocols have been used in liver transplantation. At our institution, muromonab-CD3 (OKT3) is used in patients with acute renal failure (ARF), along with a delay in starting a calcineurin inhibitor. This study was conducted to compare outcomes in liver transplant patients with ARF who received OKT3 and those who did not. From 1988 to 2007, ARF was present in 1685 of 2587 patients (65%). OKT3 was used in 109 patients (OKT3 group). The control group (1416 patients) received a low-dose calcineurin inhibitor. The OKT3 group was more critically ill. In spite of this, the OKT3 group patients who were on renal replacement therapy (RRT) achieved long-term survival similar to that of the control group on RRT. Among the patients who were not on RRT, the OKT3 group had a higher complete recovery rate, but this did not translate into improved long-term survival. Bacterial and fungal infections were more common in the OKT3 group; however, there was no increased risk of malignancy or death from hepatitis C recurrence. The use of OKT3 in patients with ARF allowed more critically ill patients on RRT to achieve survival rates similar to those of patients who did not receive OKT3.
Insights
Muromonab-CD3 (OKT3) in liver transplant patients with acute renal failure (ARF) showed similar long-term survival for those on renal replacement therapy (RRT). This approach allowed critically ill patients to achieve comparable outcomes.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Acute renal failure (ARF) is common in liver transplant recipients.
- Muromonab-CD3 (OKT3) is used at our institution for ARF with delayed calcineurin inhibitor initiation.
- Outcomes of OKT3 use in liver transplant patients with ARF require evaluation.
Purpose of the Study:
- To compare outcomes in liver transplant patients with ARF who received muromonab-CD3 (OKT3) versus those who did not.
- To assess the impact of OKT3 on survival and renal recovery in liver transplant recipients with ARF.
Main Methods:
- Retrospective cohort study from 1988 to 2007.
- Included 1685 liver transplant patients with ARF (65% of total).
- Compared 109 patients receiving OKT3 (OKT3 group) with 1416 patients on low-dose calcineurin inhibitors (control group).
Main Results:
- The OKT3 group was more critically ill.
- Long-term survival was similar for OKT3 and control groups on renal replacement therapy (RRT).
- OKT3 group had higher complete renal recovery but no improved long-term survival in non-RRT patients. Increased bacterial/fungal infections observed, but no increased malignancy or hepatitis C recurrence mortality.
Conclusions:
- Muromonab-CD3 (OKT3) use in liver transplant patients with ARF enables critically ill patients on RRT to achieve survival rates similar to controls.
- OKT3 may offer a viable immunosuppressive strategy for select liver transplant recipients with ARF, particularly those requiring RRT.
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