OKT3 induction and steroid-free maintenance immunosuppression for treatment of high-risk heart transplant recipients

M. Prieto, K. D. Lake, M. R. Pritzker, C. R. Jorgensen, K. V. Arom, K. R. Love, R. W. Emery

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Abstract

A group of high-risk heart transplant patients (n = 35) were treated from May 1987 through June 1990, with murine-derived monoclonal CD3 antibody (OKT3) induction therapy and steroid-free maintenance immunosuppression. This group was compared with a group of transplant patients (n = 47) who were not considered high risk and who were treated simultaneously with triple-drug immunosuppression (cyclosporine, azathioprine, and prednisone). The 1- and 3-year actuarial survival rates were similar: 97% and 91% for the OKT3 and 92% and 85% for the triple-drug immunosuppression groups, respectively. The overall incidence of rejection was equal for both groups (56%). No rejection occurred during the OKT3 course and rejection episodes occurred significantly later in patients treated with OKT3, with a mean first rejection episode of 111 ± 104 days versus 27 ± 21 days for the triple-drug immunosuppression group (p ≤ 0.05). Bacterial infections were seen more frequently (29% vs 6% of the patients treated) in the early period (< 3 months) in the OKT3 group (p = 0.01) and were associated with the use of mechanical assistance in this group. The incidence of late infections or cytomegalovirus disease was similar for both groups. Patients treated with OKT3 and subsequent steroid-free maintenance immunosuppression had no significant posttransplantation increases of serum cholesterol levels, and hypertension was less common. Initial hospitalization was longer (p ≤ 0.05) in the OKT3 group (23 ± 19 vs 13 ± 5 days) but after the initial discharge the number of hospital days for the first year was similar for both groups (8 ± 14 vs 9 ± 13 days). Ventricular function at 1 year after transplantation was similar for both groups with average ejection fraction of 57% and 59% for the OKT3 and triple-drug immunosuppression groups, respectively. In conclusion, high-risk patients treated with OKT3 and steroid-free maintenance immunosuppression were managed on smaller doses of immunosuppressive drugs in the early postoperative period, and had excellent long-term survival rates. In this group of patients, rejection was delayed and the incidence of hypercholesterolemia, hypertension, and steroid-induced complications was decreased. Such a regimen offers a relatively drug-free period in the early posttransplant stages and freedom from the long-term complications of steroids.

Original languageEnglish (US)
Pages (from-to)901-911
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume10
Issue number6
StatePublished - 1991
Externally publishedYes

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Muromonab-CD3
Immunosuppression
Steroids
Maintenance
Pharmaceutical Preparations
Therapeutics
Murine-Derived Monoclonal Antibodies
Incidence
Survival Rate
Hypertension
Transplants
Transplant Recipients
Ventricular Function
Azathioprine
Cytomegalovirus Infections
Immunosuppressive Agents
Prednisone
Hypercholesterolemia
Bacterial Infections
Postoperative Period

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Prieto, M., Lake, K. D., Pritzker, M. R., Jorgensen, C. R., Arom, K. V., Love, K. R., & Emery, R. W. (1991). OKT3 induction and steroid-free maintenance immunosuppression for treatment of high-risk heart transplant recipients. Journal of Heart and Lung Transplantation, 10(6), 901-911.

OKT3 induction and steroid-free maintenance immunosuppression for treatment of high-risk heart transplant recipients. / Prieto, M.; Lake, K. D.; Pritzker, M. R.; Jorgensen, C. R.; Arom, K. V.; Love, K. R.; Emery, R. W.

In: Journal of Heart and Lung Transplantation, Vol. 10, No. 6, 1991, p. 901-911.

Research output: Contribution to journalArticle

Prieto, M, Lake, KD, Pritzker, MR, Jorgensen, CR, Arom, KV, Love, KR & Emery, RW 1991, 'OKT3 induction and steroid-free maintenance immunosuppression for treatment of high-risk heart transplant recipients', Journal of Heart and Lung Transplantation, vol. 10, no. 6, pp. 901-911.
Prieto, M. ; Lake, K. D. ; Pritzker, M. R. ; Jorgensen, C. R. ; Arom, K. V. ; Love, K. R. ; Emery, R. W. / OKT3 induction and steroid-free maintenance immunosuppression for treatment of high-risk heart transplant recipients. In: Journal of Heart and Lung Transplantation. 1991 ; Vol. 10, No. 6. pp. 901-911.
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abstract = "A group of high-risk heart transplant patients (n = 35) were treated from May 1987 through June 1990, with murine-derived monoclonal CD3 antibody (OKT3) induction therapy and steroid-free maintenance immunosuppression. This group was compared with a group of transplant patients (n = 47) who were not considered high risk and who were treated simultaneously with triple-drug immunosuppression (cyclosporine, azathioprine, and prednisone). The 1- and 3-year actuarial survival rates were similar: 97{\%} and 91{\%} for the OKT3 and 92{\%} and 85{\%} for the triple-drug immunosuppression groups, respectively. The overall incidence of rejection was equal for both groups (56{\%}). No rejection occurred during the OKT3 course and rejection episodes occurred significantly later in patients treated with OKT3, with a mean first rejection episode of 111 ± 104 days versus 27 ± 21 days for the triple-drug immunosuppression group (p ≤ 0.05). Bacterial infections were seen more frequently (29{\%} vs 6{\%} of the patients treated) in the early period (< 3 months) in the OKT3 group (p = 0.01) and were associated with the use of mechanical assistance in this group. The incidence of late infections or cytomegalovirus disease was similar for both groups. Patients treated with OKT3 and subsequent steroid-free maintenance immunosuppression had no significant posttransplantation increases of serum cholesterol levels, and hypertension was less common. Initial hospitalization was longer (p ≤ 0.05) in the OKT3 group (23 ± 19 vs 13 ± 5 days) but after the initial discharge the number of hospital days for the first year was similar for both groups (8 ± 14 vs 9 ± 13 days). Ventricular function at 1 year after transplantation was similar for both groups with average ejection fraction of 57{\%} and 59{\%} for the OKT3 and triple-drug immunosuppression groups, respectively. In conclusion, high-risk patients treated with OKT3 and steroid-free maintenance immunosuppression were managed on smaller doses of immunosuppressive drugs in the early postoperative period, and had excellent long-term survival rates. In this group of patients, rejection was delayed and the incidence of hypercholesterolemia, hypertension, and steroid-induced complications was decreased. Such a regimen offers a relatively drug-free period in the early posttransplant stages and freedom from the long-term complications of steroids.",
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AU - Arom, K. V.

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AU - Emery, R. W.

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N2 - A group of high-risk heart transplant patients (n = 35) were treated from May 1987 through June 1990, with murine-derived monoclonal CD3 antibody (OKT3) induction therapy and steroid-free maintenance immunosuppression. This group was compared with a group of transplant patients (n = 47) who were not considered high risk and who were treated simultaneously with triple-drug immunosuppression (cyclosporine, azathioprine, and prednisone). The 1- and 3-year actuarial survival rates were similar: 97% and 91% for the OKT3 and 92% and 85% for the triple-drug immunosuppression groups, respectively. The overall incidence of rejection was equal for both groups (56%). No rejection occurred during the OKT3 course and rejection episodes occurred significantly later in patients treated with OKT3, with a mean first rejection episode of 111 ± 104 days versus 27 ± 21 days for the triple-drug immunosuppression group (p ≤ 0.05). Bacterial infections were seen more frequently (29% vs 6% of the patients treated) in the early period (< 3 months) in the OKT3 group (p = 0.01) and were associated with the use of mechanical assistance in this group. The incidence of late infections or cytomegalovirus disease was similar for both groups. Patients treated with OKT3 and subsequent steroid-free maintenance immunosuppression had no significant posttransplantation increases of serum cholesterol levels, and hypertension was less common. Initial hospitalization was longer (p ≤ 0.05) in the OKT3 group (23 ± 19 vs 13 ± 5 days) but after the initial discharge the number of hospital days for the first year was similar for both groups (8 ± 14 vs 9 ± 13 days). Ventricular function at 1 year after transplantation was similar for both groups with average ejection fraction of 57% and 59% for the OKT3 and triple-drug immunosuppression groups, respectively. In conclusion, high-risk patients treated with OKT3 and steroid-free maintenance immunosuppression were managed on smaller doses of immunosuppressive drugs in the early postoperative period, and had excellent long-term survival rates. In this group of patients, rejection was delayed and the incidence of hypercholesterolemia, hypertension, and steroid-induced complications was decreased. Such a regimen offers a relatively drug-free period in the early posttransplant stages and freedom from the long-term complications of steroids.

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