Thistlethwaite J R, Stuart J K, Mayes J T, Gaber A O, Woodle S, Buckingham M R, Stuart F P
Department of Surgery, University of Chicago Medical Center, IL 60637.
Am J Kidney Dis. 1988 Feb;11(2):112-9. doi: 10.1016/s0272-6386(88)80192-6.
Complications of OKT3 therapy were studied in 122 treatment episodes in renal allograft recipients (83 for rejection treatment, 39 for immunosuppression induction). A febrile first-dose reaction to OKT3 was common; no severe pulmonary complications were encountered. Other toxicities of OKT3 therapy were observed later in the treatment course. Most severe were the occurrence of aseptic meningitis in four patients (3%), and seizures in eight (6%). Seizures occurred only when OKT3 was given to patients with nonfunctioning grafts due to acute tubular necrosis. Infections were the only significant late adverse sequelae of OKT3 therapy and occurred more frequently after multiple exposures to the drug (53%) than after a single exposure (22%). IgG antibodies to OKT3 developed after 45% of exposures to the drug in the 74 patients in whom appearance of anti-OKT3 antibodies was monitored. In two patients (3%), anti-OKT3 antibodies were detected before the end of the OKT3 treatment course, neutralizing the immunosuppressive property of the drug. In five patients (7%), strong anti-OKT3 antibody responses were present at the time of subsequent rejection, which precluded reuse of the drug. In 17 other cases, no or only a weak anti-OKT3 response was detectable at the time of rejection following initial OKT3 exposure. Retreatment with OKT3 was successful in reversing rejection in 15 cases (88%). No untoward sequelae were noted after reexposure to OKT3, except the high incidence of subsequent infections.
在122例肾移植受者的治疗过程中（83例用于抗排斥治疗，39例用于免疫抑制诱导），对OKT3治疗的并发症进行了研究。首次使用OKT3时出现发热反应很常见；未遇到严重的肺部并发症。OKT3治疗的其他毒性反应在治疗后期出现。最严重的是4例患者（3%）发生无菌性脑膜炎，8例患者（6%）发生癫痫发作。癫痫发作仅发生在因急性肾小管坏死导致移植肾无功能的患者使用OKT3时。感染是OKT3治疗唯一显著的晚期不良后遗症，多次接触该药物后感染发生率（53%）高于单次接触（22%）。在74例监测抗OKT3抗体出现情况的患者中，45%接触该药物后产生了抗OKT3 IgG抗体。2例患者（3%）在OKT3治疗疗程结束前检测到抗OKT3抗体，使药物的免疫抑制特性失效。5例患者（7%）在随后发生排斥反应时出现强烈的抗OKT3抗体反应，导致无法再次使用该药物。在另外17例病例中，初次接触OKT3后发生排斥反应时未检测到或仅检测到微弱的抗OKT3反应。15例患者（88%）再次使用OKT3成功逆转了排斥反应。再次接触OKT3后，除了随后感染发生率较高外，未发现其他不良后遗症。
