Shaddy R E, Bullock E A, Morwessel N J, Hannon D W, Renlund D G, Karwande S V, McGough E C, Hawkins J A
Department of Pediatrics, University of Utah, Salt Lake City.
J Heart Lung Transplant. 1993 May-Jun;12(3):434-9.
The purpose of this study was to review our experience with the use of OKT3 (a murine monoclonal CD3 antibody) used as immune prophylaxis for pediatric heart transplant recipients. Orthotopic heart transplantation was performed in 18 pediatric patients, 8 girls and 10 boys, ranging in age from 17 days to 17 years. OKT3 therapy was initiated intraoperatively at a dose of approximately 0.2 mg/kg and was administered at a dose of approximately 0.1 to 0.2 mg/kg/day for a period of 11.5 +/- 2.5 days. Daily average OKT3 levels were 1132 +/- 469 ng/ml. Side effects that occurred during OKT3 therapy were fever (59%), diarrhea (24%), headaches (24%), vomiting (18%), encephalopathy (12%), pulmonary edema (6%), and rash (6%). Infections occurred in 24% of patients, all within 6 months of transplantation. In the first year after transplantation, patients experienced 3.4 +/- 2.4 episodes of mild rejection and 1.0 +/- 0.8 episodes of moderate rejection. No patient experienced severe rejection. Five of the surviving 14 patients (36%) have been weaned from chronic steroid therapy, and 42% are being maintained on alternate-day prednisone at a dose of 0.06 +/- 0.02 mg/kg/day. Coronary artery disease developed in three patients; two of whom died. Actuarial survival was 83% at 1 year and 73% at 2 years. This report shows that OKT3 prophylaxis in pediatric heart transplantation can be used with acceptable short-term adverse side effects and overall survival.
本研究的目的是回顾我们使用OKT3（一种鼠源性单克隆CD3抗体）对小儿心脏移植受者进行免疫预防的经验。18例小儿患者接受了原位心脏移植，其中8例女孩，10例男孩，年龄从17天至17岁不等。术中开始使用OKT3治疗，剂量约为0.2mg/kg，然后以约0.1至0.2mg/kg/天的剂量给药，持续11.5±2.5天。OKT3的每日平均水平为1132±469ng/ml。OKT3治疗期间出现的副作用包括发热（59%）、腹泻（24%）、头痛（24%）、呕吐（18%）、脑病（12%）、肺水肿（6%）和皮疹（6%）。24%的患者发生感染，均在移植后6个月内。移植后的第一年，患者经历了3.4±2.4次轻度排斥反应和1.0±0.8次中度排斥反应。没有患者发生严重排斥反应。14例存活患者中有5例（36%）已停用慢性类固醇治疗，42%的患者隔天服用泼尼松，剂量为0.06±0.02mg/kg/天。3例患者发生冠状动脉疾病；其中2例死亡。1年时的精算生存率为83%，2年时为73%。本报告表明，小儿心脏移植中使用OKT3进行预防，其短期不良反应和总体生存率是可以接受的。
