OKT3 treatment of cardiac allograft rejection

Since the initial report of the murine monoclonal antibody OKT3 for acute kidney rejection, a significant body of information has been collected regarding the efficacy of OKT3 in reversing acute allograft rejections in kidney, liver, and heart transplant recipients. The use of OKT3 therapy for the reversal of cardiac allograft rejection in patients in whom other therapeutic alternatives have failed or are contraindicated is described. Treatment with OKT3 reversed acute heart rejection in 102 of 113 patients (90%). Complete reversal was achieved in 63 patients, and partial reversal in 39 patients. At 2 years, graft and patient survival rate was 77% and 65%, respectively. No significant differences were noted in reversal rate and in 12-month graft and patient survival rates between those patients experiencing one rejection episode and those patients experiencing two or more rejection episodes. Comparable reversal rates and graft and patient survival rates were achieved in patients whether OKT3 was administered as the primary rejection therapy or as rescue therapy. Adverse events were common in the first 2 days of therapy, but they were well tolerated in most patients. Infectious complications occurred in 49% of patients in whom most infections were not serious. On the basis of this experience, OKT3 appears highly effective in reversing acute cardiac allograft rejection.