Monoclonal antibody OKT3 therapy in pediatric kidney transplant recipients

Michael R. Leone, John M. Barry, Steven R. Alexander, Tyrone Melvin, Jane Striegel, Kim Reller, Karen R. Henell, Jess Kimball, M. B. Funnell, Gideon Goldstein, Douglas J. Norman

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Thirty-one pediatric patients with acute renal allograft rejection were treated with the monoclonal antibody OKT3. In 24 cases, increased doses of steroids followed by a polycolonal antithymocyte globulin were ineffective in reversing the rejection episode. Twenty-eight patients completed the prescribed minimum 10-day treatment course, with effective rejection reversal in 22. Three patients failed to complete the course of therapy: one because of leukopenia that developed after the first dose, one because of a clotted grafi, and another because of symptomatic cytomegalovirus infection. The overall success rate of OKT3 for rejection reversal was 74%; however, 55% of recipients had rebound rejection, and 85% of patients had detectable anti-OKT3 antibodies after completion of the course of therapy. Ten patients were treated with a second course of OKT3, and in eight of these patients, rejection was at least temporarily reversed. The starting dose of OKT3 for second-course therapy was the same as that used during first-course therapy, but in five cases the dose was increased during the course because of inadequate therapeutic response. Seven of these patients lost their grafts a mean of 6.5 months after completion of second-course therapy. We looked for anti-OKT3 antibody in nine recipients after completion of a second treatment course and found it in all nine. Our observations regarding a second treatment course with this monoclonal antibody preparation suggest that although rejection reversal may be observed, ultimate graft survival is poor and anti-OKT3 antibody formation is enhanced.

Original languageEnglish (US)
Pages (from-to)S86-S91
JournalThe Journal of pediatrics
Volume116
Issue number5
DOIs
StatePublished - May 1990

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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