Figure 915

The making of a monoclonal antibody. OKT3 is a mouse monoclonal antibody directed against the CD3 molecule of the T lymphocyte. OKT3 has been used either from the time of transplantation to prevent rejection or to treat an acute rejection episode. It has been shown in a randomized clinical trial to reverse 95% of primary rejection episodes compared with 75% with high-dose steroids in patients who received azathioprine-prednisone immunosuppression. In patients receiving triple therapy (cyclosporine-azathioprine-prednisone), 82% of primary rejection episodes were successfully reversed by OKT3 versus 63% with high-dose steroids. Like antilymphocyte globulin (ALG), reduction of concomitant immuno-suppression (discontinuation of cyclosporine and reduction of azathioprine or mycophe-nolate mofetil dose) decreases the incidence of infectious complications. Side effects include fever, rigors, diarrhea, myalgia, arthralgia, aseptic meningitis, dyspnea, and wheezing, but these rarely persist beyond the second day of therapy.

Release of tumor necrosis factor (TNF), interleukin-2, and interferon gamma in serum are found after OKT3 injection. The acute pulmonary compromise due to a capillary leak syndrome rarely has been seen because patients are brought to within 3% of dry weight before initiation of OKT3 treatment. Infectious complications, particularly infection with cytomegalovirus, are increased after multiple courses of OKT3.

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