Esquivel, CO

Fung, JJ

Gordon, RD

Iwatsuki, S

Makowka, L

Markus, BH

Starzl, TE

English

PubMed

D-Scholarship@Pitt

b Efrect of OKT3 on SurYi •• l and Rate of Retransplantation D.H. Markua, J.J. Fung, R.D. Gordon. S. Iwata";, C.O. Esquivel. L. Mlkowtul .... d T.E. Stn W B HAVE previously reported the re~ultA nf nur .,ilot randomi* trial lJ and our later extended series of 157 liver allOilraft reclpienu~ treated with the mouse antihuman T cell antibody OK.T3 (Ortho-clone OKT3, OrlhoPharmaceutical Corpora-tion, Raritan. NJ) for treatment of acute hepatic allograft rejection. An additional 93 liver transplant patients have been treated with OKTJ .inee tbe Io.st inYeltiption and were Ineludec1 In tbts study. retransplantation. and 41 patients (16.4") died. Group :2 ~tiK"D1 bad luporior ... "h,: 19 (11.R%) hAd flldetion,nl allografts, and the I.year ~urvival reached 74.1% t:or eompar.· tive purposes additional data for all liver lnulIJ)lant recipients from AUIUll 1983 to June 1986 nol treated with OKT3 were deter-mined. or 362 Bra(" 181 (50.0%) were func-tioning at the boeinllin8 of Mareh 1987 with an actuarial l-)l.ar 5larvival of 53.3% {Table I). ME I HOI)S DISCUSSION 8ct", .. k~Clllbcr ., ....... JaDe 1916 O~ hepalk \ In agr6:menl with ollr previous study this a1fGeratl reclplnU J«e:I* a OXInre of Ol!.I'J. l'OIIOW·up· . . "D~ •• -' - ffi f OKT3 . data '4rCnIavallabla In 111250 J*iaau anti1 the beaiMina rnvest~Uatlon Suu-.;o.a tll9 e cacy 0 • III J M....m I9I' • ..nth. _n tvlllJw •• p limo d 4l2.'. reYefSlng acute hepallc alltl8",'t rejection. JOZ.7 da)So Bueli .. Im .... lICIUppreMm eauitted or Our initial ftndllllS have also been verified by ~poriaC (c.) and 1terVlda. CUIIcaI ucI bialOIOlIa another c:emer.' The optimal response to cn&eM IorMlae '" OKT3 tlMtapy .. -II .. priadpl- of OKT J occurred In ,roup 2 patients in whom OlD tlMta,y ill conjlUldion with Cs IIWlIfeloidJ hlwe II --" cd ,a-.,: • ~ ulallwly delcribod prcvlollsiyP" cc -.. -.lat re,,_ .. oo wal tbl! primary cause A~ wu performed ui.,lhc pmoiouIlydccribcd uf postoperative UYer allograft dysfunction • .,.IIia, schane rOl aJJosraft rcc:ipien ... , Briel" in The less tban optimal response rate in groups ..-P' r-"-" OKTJ 'M. __ a ......... It ... I_lila" I add ;, r.fhK •• 000000\;,*11& prWGJKlI. ic;, an tell da~ poItoperadvely; in IfOUP 2 puienu mallnCM element of coexistin, ischemIc injury and WUltarted ten daY' to tbree IDCIIttha poIIOpIntively: IOd •. Ia 1M' 3 .... 1.11& .. ,..1_1 wu.tanaI. ._ .... renal fa,lu", 1ft SfOUP 1 And • ".ree of ,..... •• ar-_..-a b .. i' 3 lIsree montlls ~yK c roOK; reject on,ln lJ'Oup • RESULTS The average age or rile 2'0 OKTJ.treated patients was 28.4 ::t 18.3)a1'l. Eipty-SCYeD patients woro ohildnm (iliAD a,Co 6.3 ::t '.4 years). and 163 were adults (mean .. 40.2 : 11.2 yean). Two hundred t'WODty-oaC EUUK4~F paliCAta had lhclr .fiBt pafl. and the other 29 (11.6"') hArt undersone retransplantation bJON reMivjnl OKT3 (TaWo I). Tbe rt$J)OnIc to OKlJ thoragy WII detara mined a. lurvivat of the al1osraft. At the be8innlns of March 1987, 146 EpUK4~F PU_IS treated with OkD bad fllDCtioniD8 alIosrafts with an a«aariall·year ,urvival of 61.0%. Smy-three pationtl EOpKO~F needed An important bMeil or this draa was obselYCd in patients who have historically done poorly. These petienlS typically I'rsellt with hepatic allograft dy.cunclion in the early ,.,." .. ~ of~K VIfI.,.",,,o/l'It',.. Hrp. ~I HMIrIt ec..w lI/ l'It1s1Jw." 1IIfIl1'-r.,,,.,., M"...".1oII, I'll,."",. p~ 6)' ~ "..., /,.. fA. V""..'" A~ffff"""1iffff .. ", NOIIDMI htnUIIU' of H.llIe Gmlll No. AMo3ttt(' Il.H.N. " ,II. NdJIMI rl/ OIfIUttr F",."," ... .,.., .. ~ .R__ Jt,u_ Mlp. ~ .. prbIt,....,. to T.E. S,on'. MD. ~ "." Of ~"IKKIK t .. ,..uI1lll:-f,,, W. VIII'msf" of"''''' bwP. PIli""'" PAIS:MI. C 1987 I1p c;,... '" SIMI"",. 'w-0011-1 ''''fl1/I9tH-WI 'SlJJJJ(J/O {I I I} P02/03 01-2S-93 03:51PM OOOS/PITT-falk b {I I I} P03/03 , ~ . A T ..... 1 ........ a ... iii 11II ........ I .... O"V_ ...... lit UMr.,... ................ T ......... ..,. ... ." ... -t-v. ..... <hoe ..... ............. c .. f!e'Jll1t&I .,.. ... . ... " ........ 1 11. 17147.') • ",.1. 2&C20.2) QA .u 2 no 'fa'.., 1'1118.1) t.UI.71 7U 12.2 :a 2' 10M'" ... " IC'''' 71.4 17.1 14 210 141"'.' .... .., ......... , 0&.0 73-" "'CIICTI· HIt '.'CM.Ol to~ .1111.1, DU 11.' · ......... ...-_b ................................. CIIt13r.--.... , ........... __ ...... poIllraapiant period and usually have addi. tional metabolic tteranaemenu, geatrally teO",""... • pnartou preoperative It&tUl. SIIOh pation ... OIpoGiaUy if tbe, .,.,..., with ... "i&loul dolMftt 0( oollulal r.jNiun, appcancl 10 bnefil by a normalized ,raft tUJlCdon from OKT3 th .... py. Rejection it a major factOr illl.eneillS the need lor relftlftlpa.-ntation.' Durin, the o~=cfed folkJw.up period ,be rcuaapIanta .. lion rate aPl)lllam1 to diminilb .... t1y in IfGUP 2 patiOlrtl proscntina primarily with edl-mediated rejeaion. The hiPar rate of. rctraD$plantltion seen in Ito"P 1 and Irov.P 3 patients poaibly reftcc;ts lhc inability of OKT3 to rovOl'SC lhe sign. of concomitant disoaso disorders. The 4ccrcalCd need ror rotfanaplantalion is rc8cc&ccI ill tbe ... rvival of hopatlo allcan&. A ,Iplficana illcnuo in alJoaratt larviYal WU dllllOl1ltrated. no major bonofil ... Mea m aroup l paUnu, who bad a IUperior 1·,., l1aft survival (Table .). In ar-p I .,..11 ....... n IUrYIftJ approximaled &hal ia lbI historic control aroup. "I'heM 6_. ... .. t. Lila, OKT3 bu affected tile averal1 .ucc:eu of liver tnnlplu. tatioll wit. r.peot to .IJoar.n lWYiYal Ut palients -itb documented li..- rejection. TIlt normalization ollUmttal eurves in ..-p I palienll"'geIU that OKT3alIO hu a role in thao critically HI patients I. In added trest-men. for early rejection and/or prophyluia in pationts in whom Ca tborapy mUlt be halldJed tautioualy. ThIlS OKT3, ill conjunction with Cs and steroids. hu improved the treatmenl of bopatic: aUopall njec:lion. REFERENCES I. F ... JJ. o...wIa AJ ...... k.- ali HcpIIrw (In .... ) 2 ......... n. Jt-. UI T._ ........... '..,37. I," 3. FuaJJ. Matku BIl. Oordoa RD •• aI: T ...... _ ... 19:". IS.' ( .. ". I) ... &I(.mI CO. ""III JJ. MarIUI 1111. ct al: T .... plain Proo 19',ZM'.lt11 5. c.imi AI. ClIo SL IWIDOIIioo FL " ,I: T .... p1ut Proo 19=2'll,'911 ,. Sha. n. a.-. RD, J......w S. ., II: ..... ~ Dit 5:SM3, 1916 A tat I tnl stu • ben live deg sur, live anti tr." witt-· , .. ,. 06" live, eWet pia,,' bype sbA allop ...... Ct'nt. ... .110(. i,bin: _ recip: traM; .boWI speeil WI of dol planl our I deeRe with I fact c cJl'ect. 

Effect of OKT3 on survival and rate of retransplantation

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Effect of OKT3 on survival and rate of retransplantation

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