Whiting J F, Fecteau A, Martin J, Bejarano P A, Hanto D W
Department of Surgery, University of Cincinnati Medical Center, Ohio 45267-0558, USA.
Transplantation. 1998 Feb 27;65(4):577-80. doi: 10.1097/00007890-199802270-00022.
A pilot study was performed to prospectively evaluate the safety and efficacy of "low-dose" OKT3 induction after liver transplantation.
Sixteen patients received a 5- to 10-day course of OKT3 (2.5 mg i.v. daily) along with azathioprine, prednisone, and the delayed introduction of cyclosporine (Neoral).
Patient and graft survival rates at 1 year were 88% and 82%. Five patients (31%) had biopsy-proven rejection; all five were treated successfully with steroids. There were 15 infections in 12 patients, including 5 cytomegalovirus infections. Adverse events attributed to OKT3 consisted of low-grade fever (five patients), transient hypoxemia (three patients), and transient hypotension (two patients). Pharmacy acquisition costs for OKT3 averaged $2,139 less as compared to a group of historical controls receiving full-dose therapy.
Low-dose OKT3 induction appears to be a safe and useful method of postoperative immunosuppression after liver transplantation. Its ultimate clinical, immunologic, and economic efficacy awaits determination by randomized trial.
进行了一项前瞻性试点研究，以评估肝移植后“低剂量”OKT3诱导治疗的安全性和有效性。
16例患者接受了为期5至10天的OKT3疗程（每日静脉注射2.5毫克），同时使用硫唑嘌呤、泼尼松，并延迟引入环孢素（新山地明）。
1年时患者和移植物存活率分别为88%和82%。5例患者（31%）经活检证实发生排斥反应；所有5例均用类固醇成功治疗。12例患者发生了15次感染，包括5次巨细胞病毒感染。归因于OKT3的不良事件包括低热（5例患者）、短暂性低氧血症（3例患者）和短暂性低血压（2例患者）。与一组接受全剂量治疗的历史对照相比，OKT3的药房采购成本平均少2139美元。
低剂量OKT3诱导似乎是肝移植后术后免疫抑制的一种安全且有用的方法。其最终的临床、免疫学和经济效益有待通过随机试验确定。
