Prophylactic OKT3 Used as Induction Therapy for Heart Transplantation

Starnes, Vaughn A. MD
Oyer, Philip E. MD
Stinson, Edward B. MD
Dein, John R. MD
Shumway, Norman E. MD

From the Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, California.

Address for correspondence: Vaughn A. Starnes, MD, Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, CA 94305.

Supported by grant HL-08696 from the National Heart, Lung, and Blood Institute, National Institutes of Health.

Circulation 80(5):p III-83, November 1989.

The benefit of an immunosuppressive agent should be demonstrated by less rejection, less toxicity, decreased hospital stay, and equal or superior patient survival. Since June 1987, a total of 61 patients have received prophylactic OKT3 for 14 days, beginning on postoperative day 1, in addition to cyclosporine, azathioprine, and prednisone (group 1). Group 1 was compared with our conventional-therapy group (group 2, n = 116) treated with cyclosporine, azathioprine, prednisone, and antithymocyte globulin. The hospital stay was reduced from 36 to 22 days (p < 0.0001). The linearized rejection rate was reduced with OKT3 from 2.82 to 1.09 (p < 0.0002), from 1.82 to 1.45 (p < 0.02), and from 1.22 to 0.56 (p < 0.04) during the first 3 months, respectively. Actuarial freedom from rejection at 12 months was 32% versus 12% (p < 0.005). Antimurine antibodies developed in 12.7% of OKT3-treated patients.