Primary failure of OKT3 antibody for rejection prophylaxis in orthotopic heart transplantation

Cytolytic immunosuppression with OKT3 antibody has been shown to be highly effective in reducing the frequency of early allograft rejection in cardiac transplantation. Failure of OKT3 immunosuppression in the absence of anti-OKT3 antibodies is a rare event, having been reported in only 3 patients who manifested predominantly vascular (humoral) rejection during OKT3 therapy. We report the first case of hemodynamically serious cellular rejection, without a demonstrable vascular rejection component, in a cardiac allograft recipient during OKT3 treatment. This case underscores the need to remain vigilant for signs of rejection in cardiac recipients during OKT3 immunosuppression.