Prophylactic OKT3 used as induction therapy for heart transplantation

The benefit of an immunosuppressive agent should be demonstrated by less rejection, less toxicity, decreased hospital stay, and equal or superior patient survival. Since June 1987, a total of 61 patients have received prophylactic OKT3 for 14 days, beginning on postoperative day 1, in addition to cyclosporine, azathioprine, and prednisone (group 1). Group 1 was compared with our conventional-therapy group (group 2, n = 116) treated with cyclosporine, azathioprine, prednisone, and antithymocyte globulin. The hospital stay was reduced from 36 to 22 days (p less than 0.0001). The linearized rejection rate was reduced with OKT3 from 2.82 to 1.09 (p less than 0.0002), from 1.82 to 1.45 (p less than 0.02), and from 1.22 to 0.56 (p less than 0.04) during the first 3 months, respectively. Actuarial freedom from rejection at 12 months was 32% versus 12% (p less than 0.005). Antimurine antibodies developed in 12.7% of OKT3-treated patients.