03192nas a2200385   4500008003900000245006000039210006000099260000800159300001200167490000700179520199200186653002102178653004702199653005902246653001802305653006902323653001102392653003202403653002702435653002602462653004602488653004502534653001702579100001502596700001902611700001902630700001702649700001202666700001302678700002002691700001902711700001602730700001602746856004402762       1989                          d00aSuccessful retreatment of allograft rejection with OKT30 aSuccessful retreatment of allograft rejection with OKT3  cJan  a88 - 910 v473 aOKT3 is a murine monoclonal antibody to the CD3 antigen of human T lymphocytes. The production of human antimurine antibodies after treatment with OKT3 has been perceived as a major limitation to its extended use and reuse. Treatment of 142 patients with 168 courses of OKT3 resulted in the development of antimouse antibody in 28% of the patients. Twenty-six patients (16 kidney, 6 liver, 3 heart, 1 pancreas) have been retreated with 27 courses of OKT3. Eighteen patients had no antimurine antibodies present, and the rejection reversal rate was 83% (15/18). Six patients had a low-titer antimurine antibody present, and rejection reversal occurred in 5 (83%). Rejection was not reversed in 2 patients with a high-titer antibody. Development of antimurine antibody was more frequent in renal transplant recipients (33%) than in hepatic (12%) or cardiac transplant recipients (18%). We believe that this reflects the fact that concomitant immunosuppressive therapy is more likely to be reduced during OKT3 therapy in renal transplant recipients than in hepatic or cardiac transplant recipients. Retreatment of patients with no anti-OKT3 antibody resulted in depletion of CD3+ cells from the peripheral blood, but it took longer than in patients being treated with OKT3 for the first time. Similarly, serum OKT3 levels rose more slowly in retreated patients compared to first treatment. In retreating patients with a low-titer antimurine antibody, it often was necessary to increase the dose of OKT3 in order to achieve adequate serum OKT3 levels and to deplete CD3+ cells. De novo antimurine antibody developed in 4 of the 18 (22%) antibody-negative patients who were retreated. In conclusion, retreatment with OKT3 should not be considered unless the antibody status of the patient is known. Development of low-titer antibodies does not preclude successful retreatment with OKT3; however, alternate antirejection therapy should be used in patients with high-titer antimurine responses.10a*Graft Rejection10aAntibodies, Anti-Idiotypic / *biosynthesis10aAntibodies, Monoclonal / immunology / *therapeutic use10aAntigens, CD310aAntigens, Differentiation, T-Lymphocyte / analysis / *immunology10aHumans10aImmunosuppression / methods10aKidney Transplantation10aLiver Transplantation10aLymphocytes / classification / immunology10aReceptors, Antigen, T-Cell / *immunology10aTime Factors1 aFirst, M R1 aSchroeder, T J1 aHurtubise, P E1 aMansour, M E1 aPenn, I1 aMunda, R1 aBalistreri, W F1 aAlexander, J W1 aMelvin, D B1 aFidler, J P  uhttp://613633.bywedr.asia/reference/516