The Cardiopulmonary Response to OKT3 in Orthotopic Cardiac Transplant Recipients: Outcome

30 Oct

The Cardiopulmonary Response to OKT3 in Orthotopic Cardiac Transplant Recipients: OutcomeThis hyperdynamic interval ceased before the maximum elevation in temperature that occurred at three hours after the first dose. Reading here
The secondary phase, most apparent at five to seven hours after OKT3 administration, was typified by mild hypotension with systemic vasodilation. Concurrently, moderate hypoxemia was present, frequently requiring an increase in supplemental oxygen therapy. This increase in the alveolar-arterial oxygen gradient was accompanied by a fall in pulmonary vascular resistance, perhaps altering hypoxic pulmonary vasoconstriction. This later phase exhibited changes in cardiopulmonary function consistent with altered vasomotor tone.

Several sequelae of administration of OKT3 have been reported in transplant populations. In 1985, the Ortho Multicenter Transplant Study Group, in describing the experience in recipients of renal transplants, noted that systemic reactions were limited to the first and, to a lesser extent, the second injections. These investigations quoted a response frequency including 73 percent pyrexia, 21 percent dyspnea, 14 percent chest pain and tightness, and 11 percent wheezing. They also described five cases of pulmonary edema attributed in part to fluid overload in association with rejection. Their conclusion was that “the pharmacologic effects of the mediators released after the first dose can impose a left ventricular strain and cause pulmonary edema, but only in patients with impending left ventricular failure due to fluid overload. In 1987, Thistlethwaite et al reported on another series of recipients of renal transplants with rejection and noted fever (96 percent), hypertension (32 percent), and hypotension (14 percent) after the first dose of OKT3. One patient in this group suffered ECG changes consistent with transient myocardial ischemia. Even the prophylactic use of OKT3 in the setting of renal transplantation resulted in similar side effects. Reported experience with OKT3 in recipients of orthotopic heart transplants is limited. Several authors have commented on the use of OKT3 in the face of rejection unresponsive to antilymphocyte globulin, steroid therapy, or both. In this situation, systemic response was again limited to early doses. There were no reports of altered cardiopulmonary function. Sweeney et al noted an aggressive effort at diuresis to within 3 percent of the patients dry weight and the presence of a clear chest roentgenogram as goals before OKT3.