OKT3 prophylaxis in renal grafts with prolonged cold ischemia times: Association with improvement in long-term survival

• Published in: Kidney international Vol. 49; no. 3; pp. 768 - 772
• Main Authors: Abramowicz, Daniel, Norman, Douglas J., Vereerstraeten, Pierre, Goldman, Michel, Pauw, Luc De, Vanherweghem, Jean-Louis, Kinnaert, Paul, Kahana, Lawrence, Stuart, Frank P., Thistlethwaite, James R., Shield, Charles F., Monaco, Anthony, Wu, Shu-Chen, Haverty, Thomas P.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1996; Nature Publishing
• Subjects: Adult; Biological and medical sciences; Cold Temperature; Cyclosporine - therapeutic use; Female; Follow-Up Studies; Graft Rejection - complications; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Graft Survival; Humans; Immunomodulators; Immunosuppressive Agents - therapeutic use; Incidence; Ischemia; Kidney Transplantation - immunology; Male; Medical sciences; Muromonab-CD3 - therapeutic use; Organ Preservation - methods; Pharmacology. Drug treatments; Prospective Studies; Time Factors; Human; Transplantation; Duration; Monoclonal antibody; Homotransplantation; Long term; Kidney; Result; Prevention; Rejection; Treatment; Urinary system; Ischemia; Surgery; Immunosuppressive agent
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.1996.106

OKT3 prophylaxis in renal grafts with prolonged cold ischemia times: Association with improvement in long-term survival. The data on patients participating in two randomized, prospective studies with similar immunosuppressive regimens were updated and combined to evaluate the long-term effects of OKT3 according to cold ischemia time (≤ or > 24 hr). Among 159 patients in the OKT3 and 153 in the cyclosporine A (CsA) group, 8 and 12 deaths occurred, respectively (P = NS). In patients with cold ischemia > 24 hours, OKT3 prophylaxis resulted in a lower mean number of rejection episodes per patient than did CsA prophylaxis within one year (mean ± sem: 0.87 ± 0.11 vs. 1.35 ± 0.14, respectively; P = 0.008) and within five years (1.07 ± 0.12 vs. 1.49 ± 0.15, respectively; P = 0.032). In contrast, rejection incidences in patients with cold ischemia ≥ 24 hours was not significantly different in the two groups. In all study patients, there was a trend towards higher graft survival rates in the OKT3 group versus the CsA group (at 5 years, 73% vs. 66%, respectively; P = 0.182). Among recipients of kidneys with cold ischemia times > 24 hours, OKT3 patients had significantly higher graft survival than CsA patients at two years (84% vs. 64%, respectively) and at five years (71% vs. 56%, respectively; P = 0.045). Significant differences were not observed in recipients of kidneys with cold ischemia times ≤ 24 hours. In conclusion, patients receiving renal grafts with long cold ischemia times strongly benefit from OKT3 prophylaxis.