The Cardiopulmonary Response to OKT3 in Orthotopic Cardiac Transplant Recipients: Materials and Methods

27 Oct
2014

All patients were hemodynamically stable prior to OKT3 administration. Serial measurements were made one hour prior to the first dose and at one, three, five, seven, and nine hours after the first dose of OKT3. These measurements included the following: temperature; heart rate; mean arterial blood pressure (arterial line); arterial blood gas levels; SvO, (oximetry); CVP; mean pulmonary arterial and occlusion pressures (pulmonary arterial catheter); and cardiac output by thermodilution. The FIo2 and the preoperative and postoperative weights were recorded. Calculated and derived values included the following: cardiac index; SVRI; PVRI; oxygen extraction ratio (oxygen consumption/delivery), and PaO/FIo2 ratio.

Data on patients were evaluated statistically by analysis of variance methods, including paired f-tests with the Bonferroni correction. Patients acted as their own controls (values before dose vs values after dose). Results were evaluated for both statistical (p<0.05) and clinical relevance.
Results
Twenty-three serial patients randomized to receive OKT3 as part of their postoperative immunosuppressive therapy were evaluated. Sixteen of these patients were men, and seven were women, with a mean age of 50.4 years (range, 25 to 65 years). The etiology of the cardiomyopathy necessitating transplantation was idiopathic in 11 cases and ischemic heart disease in the other 12 patients. read only
All recorded physiologic parameters, both measured and derived, are reported in Table 1. The data appear as the mean ± SE, with an asterisk denoting statistical significance when compared to values before OKT3 (p<0.05; see methods).
Figure 1 displays changes in temperature and cardiovascular parameters (heart rate, mean arterial pressure, cardiac output, SVRI, oxygen extraction ratio, and Sv02) over time. Statistical significance is again denoted by an asterisk and reflects comparison to values before OKT3.
Table 1—Physiologic Barometers

DataBefore OKT3Time after First Dose of OKT3
lh3 h5 h7 h9 h
Heart rate, beats per min93±5lll±6t110 ±6t109 ±6t105 ±6t99±8
MAP, mm Hg$86±399±6t79±2t70±3t73±3t83±4
Temperature, °C36.8±0.137.3±0.2f37.9±0.2t37.7 ±0.2t37.5±0.3t37.7±0.4t
Cardiac output, L/min5.1±0.36.7±0.2t5.8±0.54.8±0.45.6±0.65.8±0.4
Cardiac index, L/min/m22.8±0.23.7±0.1t3.2±0.42.7±0.23.1 ±0.23.2±0.2
PaO^FIo2, mm Hg329 ±11287 ±23299 ±14190±17f233±19t255 ±26
SVRI, dynes*s*cm-®/m22,033 ±331,906 ±581,769 ±651,855 ±671,728 ±23t1,909 ±66
PVRI, dynes*s*cm-7m2277 ±15275 ±25260 ±21166±17f193±14t263 ±42
Oxygen extraction ratio, percent32.7 ± 1.238.9±0.6f34.2± 1.034.6± 1.335.1±1.132.6 ±1.6
SvOa, percent66±354± It62 ±559±2t58±2f61 ±5
PAoP, mm Hg§15.0±0.915.8± 1.315.3± 1.615.9± 1.615.0± 1.414.9± 1.9
CVP, mm Hg13.3±0.817.9± 1.6t14.6± 1.014.7± 1.312.5± 1.213.3 ±0.9
MPAP, mm Hg24.7± 1.328.5± 1.825.7 ± 1.821.5± 1.322.5± 1.225.4 ±1.6

 

Figure 1. Change in cardiovascular and related parameters over time. Arrow indicates OKT3 dose; asterisk indicates p<0.05 vs level before dose.

Figure 1. Change in cardiovascular and related parameters over time. Arrow indicates OKT3 dose; asterisk indicates p

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