Despite the pioneering technical achievements more than 20 years ago of prominent surgeons including Christian Barnard, Norman Shumway, and Denton Cooley, cardiac transplantation has only recently become a lifesaving procedure with acceptable long-term survival. It has been the concurrent advancement in preservation skills and perioperative and postoperative immunosuppression that is predominantly responsible for this recent success.
The murine-derived monoclonal antibody, OKT3, is among the new agents undergoing evaluation as a potential part of the immunosuppressive regimen. Concomitant with administration of initial doses of OKT3 in recipients of renal transplants has been the occasional occurrence of a variety of side effects, including dyspnea and even pulmonary edema. More info
As part of the assessment of OKT3, we sought to characterize the cardiac and pulmonary response to its administration in 23 recipients of orthotopic cardiac transplants.
Materials and Methods
After informed consent, serial patients with end-stage cardiomyopathy were admitted to a protocol approved by the institutional review board. Twenty-three patients were randomized to receive OKT3 administered within 72 hours of orthotopic cardiac transplantation as part of an immunosuppressive regimen including the following: azathioprine (4 mg/kg before surgery and 2.5 mg/kg/day after surgery); steroids (methylprednisolone, 500 mg during surgery and 375 mg in the first 24 hours after surgery; and prednisone, 20 mg/day subsequently); and cyclosporine A (begun 12 hours after surgery, titrated to whole-blood levels by radioimmunoassay of 600 to 800 ng/dL). Premedication, three hours before the first dose of OKT3, included diphenhydramine (25 mg IV), acetaminophen (650 mg orally), hydrocortisone (100 mg IV), and ranitidine (50 mg IV).