Selective OKT3 induction therapy in adult cadaveric-donor renal transplant recipients

Decreasing Medicare reimbursement for renal transplantation has placed a premium on early hospital discharge. On average, the diagnosis-related group reimbursement for renal transplantation is exhausted by the ninth hospital day at the authors' institution. Previously, the median length of hospital stay was 14 days for patients with initial graft dysfunction and 8 days for those with immediate function. In the present protocol, all patients received a single 10-mg dose of OKT3 during the transplant procedure. Those with good initial function received no further OKT3 and began receiving cyclosporine, 10 mg/kg/d, on the second posttransplant day. High-dose cyclosporine was avoided in those with poor initial function, whether they required dialysis or not. Instead, they received cyclosporine, 6 mg/kg/d and resumed OKT3, 5 mg/d, on the second day for up to a 14-day course to prevent rejection during recovery of renal function and permit early discharge. All patients received maintenance immunosuppression including cyclosporine, azathioprine, and prednisone. Of 39 adult cadaveric-donor renal transplant recipients entered in the protocol with 2 to 8 months follow-up, 13 (33%) had good graft function and received only the intraoperative dose of OKT3, 9 (23%) had poor initial function but did not require dialysis, and 17 (44%) had poor function receiving dialysis for a median duration of 15 days (range, 2-46 days). Side effects of OKT3 were well tolerated, and median hospital stays were 7 days (range, 6-11), 7 days (range, 5-14), and 9 days (range, 5-15), respectively, for the three groups. Overall patient survival was 100% and graft survival was 97% for the short follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)