EVALUATION OF OKT3 MONOCLONAL-ANTIBODY AND ANTI-THYMOCYTE GLOBULIN IN THE TREATMENT OF STEROID-RESISTANT ACUTE ALLOGRAFT-REJECTION IN PEDIATRIC RENAL-TRANSPLANTS

被引：11

作者：

MOCHON, M ^{[1
]}

KAISER, B ^{[1
]}

PALMER, JA ^{[1
]}

POLINSKY, M ^{[1
]}

FLYNN, JT ^{[1
]}

CAPUTO, GC ^{[1
]}

BALUARTE, HJ ^{[1
]}

机构：

[1] TEMPLE UNIV,ST CHRISTOPHERS HOSP CHILDREN,SCH MED,DEPT PEDIAT,SECT NEPHROL,ERIE AVE,FRONT ST,PHILADELPHIA,PA 19134

来源：

PEDIATRIC NEPHROLOGY | 1993年 / 7卷 / 03期

关键词：

RENAL TRANSPLANTATION; REJECTION; CORTICOSTEROID RESISTANT; OKT3; ANTI-THYMOCYTE GLOBULIN;

D O I：

10.1007/BF00853214

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

We reviewed the effectiveness of Muromonab-CD3 (OKT3) and anti-thymocyte globulin (ATG) in the treatment of corticosteroid-resistant acute renal allograft rejection in 49 transplanted children. Reversal of rejection was successful in 22 of 23 patients (96%) treated with OKT3 and 21 of 26 (81%) treated with ATG (P = NS). Re-rejection episodes occurred within 1 month of cessation of therapy in 9 of 22 patients treated with OKT3 but only in 2 of 21 who received ATG (P <0.05). In the patients with re-rejection, 7 of the 9 patients originally given OKT3 and 1 of the 2 who received ATG responded to a repeat course of high-dose corticosteroids; thus, at 1 month post treatment, the incidence of graft loss due to initial rejection or re-rejection was 13% for the OKT3 and 23% for the ATG group (P = NS). Graft survival was similar at 6 months: 82% for OKT3- and 73% for ATG-treated patients (P = NS); 100% patient survival was noted in both groups. Mean calculated creatinine clearance prior to, during, and at 1 and 6 months post rejection was similar in the OKT3- and ATG-treated groups. Neutropenia and thrombocytopenia occurred more frequently in the ATG group, but there was no significant difference in infectious complications. Two patients developed high (greater-than-or-equal-to 1:1,000) OKT3 antibody titers. In our experience, children with corticosteroid-resistant acute renal allograft rejection treated with OKT3 and ATG had similar allograft survival and level of renal function at 1 and 6 months, and number of infectious complications post therapy.

引用

页码：259 / 262

页数：4

共 18 条

[1]

Novick A.C., Braun W.E., Steinmuller D., Buszta C., Greenstreet R., Kiser W., A controlled randomized double-blind study of antilymphoblast globulin in cadaver renal transplantation, Transplantation, 35, pp. 175-179, (1983)

[2]

Norman D.J., Shield C.F., Barry J., Bennett W.M., Henell K., Kimball J., Funnell B., Hubert B., Early use of OKT3 monoclonal antibody in renal transplantation to prevent rejection, Am J Kidney Dis, 11, pp. 107-110, (1988)

[3]

Light J.A., Khawand N., Ali A., Bre W., Aquino A., Comparison of Minnesota antilymphocyte globulin and OKT3 for induction of immuno-suppression in renal transplant recipients, Transplant Proc, 21, pp. 1738-1740, (1989)

[4]

Filo R.S., Smith E.J., Leapman S.B., Reversal of acute allograft rejection with adjunctive ATG therapy, Transplant Proc, 13, pp. 482-490, (1981)

[5]

A randomized clinical trial of OKT3 monoclonal antibody for acute rejection on cadaveric renal transplant, N Engl J Med, 313, pp. 337-342, (1985)

[6]

Hardy M.A., Nowygrod R., Elberg A., Appel G., Use of ATG in treatment of steroid resistant rejection, Transplantation, 29, pp. 162-164, (1980)

[7]

Norman D.J., Shield C.F., Barry J., Henell K., Funnell M.B., Lemon J., Therapeutic use of OKT3 monoclonal antibody for acute renal allograft rejection, Nephron, 46, pp. 41-47, (1987)

[8]

Leone, Alexander S.R., Barry J.M., Henell K., Funnell M.B., Goldstein G., Norman D.J., OKT3 monoclonal antibody in pediatric kidney recipients with recurrent and resistant allograft rejection, J Pediatr, 111, pp. 45-50, (1987)

[9]

Schwartz G.J., Haycock G.B., Edelman C.M., A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine, Pediatrics, 58, pp. 259-263, (1976)

[10]

Hricik D.E., Zarconi J., Schulak J., Influence of low-dose cyclosporine on the outcome of treatment with OKT3 for acute renal allograft rejection, Transplantation, 147, pp. 272-277, (1989)

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