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The hemodynamic effects of intraoperative injection of muromonab CD3
S T Robinson1, J M Barry, D J Norman
1Department of Anesthesiology, Oregon Health Sciences University, Portland 97201.
Abstract:
During anesthesia 5 mg of muromonab CD3 (OKT3), an anti-CD3 monoclonal antibody, was administered prophylactically to twelve patients undergoing cadaveric renal transplantation. Preoperatively, all patients were at or near their dry body weights. Methylprednisolone 500 mg on call to or in the operating room, azathioprine 2 mg kg-1 and diphenhydramine 50 mg were administered intraoperatively to reduce the probability and severity of reported effects of OKT3. After induction of anesthesia, the patients were monitored for changes in cardiovascular variables for up to 120 min after OKT3 administration. All patients had uneventful anesthetic courses. Analysis of variance showed no significant changes from pre-OKT3 administration in heart rate, mean blood pressure, mean pulmonary artery pressure, central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance (PVRI). CVP values were a reliable indicator of PCWP with the correlation coefficient of CVP to PCWP or r = 0.78 (P < 0.00005) and PCWP = .89 x CVP + 3.78. Cardiac index (CI) increased 22% at 105 min (P < 0.05). Systemic vascular resistance index (SVRI) decreased 21% at 105 min (P < 0.05). SVRI was increased 16% at 10 min post-OKT3 (P < 0.05). All of these statistically significant values were within acceptable clinical limits. Euvolemic cadaveric renal transplant recipients receiving prophylactic steroids and diphenhydramine may receive OKT3 in the operating room for induction immunosuppression without any appreciable risk of cardiovascular compromise.
Insights
Muromonab CD3 (OKT3) administration during anesthesia for renal transplants showed no significant cardiovascular compromise in patients receiving prophylactic steroids and diphenhydramine. These findings support the safe use of OKT3 for induction immunosuppression in euvolemic transplant recipients.
Area of Science:
- Immunology
- Anesthesiology
- Nephrology
Background:
- Muromonab CD3 (OKT3), an anti-CD3 monoclonal antibody, is used for immunosuppression in organ transplantation.
- Potential cardiovascular side effects of OKT3 necessitate careful monitoring during anesthesia.
Purpose of the Study:
- To evaluate the cardiovascular effects of prophylactic muromonab CD3 (OKT3) administration during anesthesia in patients undergoing cadaveric renal transplantation.
Main Methods:
- Twelve euvolemic renal transplant recipients received OKT3 (5 mg) during anesthesia.
- Prophylactic administration of methylprednisolone, azathioprine, and diphenhydramine was given.
- Cardiovascular variables were monitored for up to 120 minutes post-OKT3 administration.
Main Results:
- No significant changes were observed in heart rate, mean blood pressure, pulmonary artery pressure, central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), or pulmonary vascular resistance index (PVRI).
- Central venous pressure (CVP) reliably indicated pulmonary capillary wedge pressure (PCWP) (r = 0.78).
- Cardiac index (CI) increased by 22% and systemic vascular resistance index (SVRI) decreased by 21% at 105 minutes post-OKT3, with transient SVRI increase at 10 minutes; all within acceptable clinical limits.
Conclusions:
- Prophylactic administration of steroids and diphenhydramine allows for the safe use of OKT3 during anesthesia for renal transplantation.
- OKT3 induction immunosuppression in euvolemic renal transplant recipients does not pose an appreciable risk of cardiovascular compromise.