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In a retrospective study, we evaluated the efficacy of OKT3 as a first-line agent in reversing histologically confirmed acute renal allograft rejection in SKP recipients. Patients with mild to moderate (corresponds to grade I using the Banff schema), moderate (Banff grade 2A) or severe acute cellular and acute vascular rejection (Banff grade 2B or 3) who had not received any other anti-rejection treatment were included in this analysis. A total of 21 patients who received OKT3 between 1989 through 1995, fulfilled these criteria. Demographics were: 13 male and 8 female; mean age 39 (range 28-51) years; 20 white and 1 black. The median time to the diagnosis of rejection from transplantation was 33 days (mean 40 days; range 10-140 days). On histology, 2 were graded as mild to moderate, 10 as moderate, and 9 as moderate to severe. The mean baseline serum creatinine was 1.3 mg/dL (0.7-2.0) and the mean serum creatinine at the time of diagnosis of rejection was 2.4 mg/dL (1.4-8. 4) (P=0.00l; paired T-test). The mean duration of OKT3 treatment was 12 days (10-18 days) The mean serum creatinine at the end of OKT3 Vestment was 1.4 mg/dL (P=0.9 compared to baseline serum creatinine, paired T-test). The mean serum creatinine (mg/dL) at baseline, diagnosis of rejection, post-OKT3, at 1,3,6 and 12 m after OKT3 treatment in the various groups were:
Rejection was reversed in all patients. Recurrent rejection occurred in 10 (48%) patients. Patient, kidney, and pancreas allograft survival at one-year post-OKT3 treatment were 95.2%, 95.2% and 95.2% (one graft loss due to death with function), and at a mean follow-up of 48 months posttransplantation were 95.2%. 71.4% and 71.4% respectively. The mean serum creatinine and blood glucose levels in the 15 patients with functioning allografts were 1.7 mg/dL (0.8-2.8) and 86 mg/dL (68-110) respectively. Anti-OKT3 antibody formation in a titer of 1:100 occurred in 7 (33.3%) patients. Conclusions OKT3 when utilized as first-line therapy reversed 100% of the acute rejection episodes, with a one-year post-OKT3 patient and graft survival of 95.2%.