Background. A pilot study was performed to prospectively evaluate the safety and efficacy of 'low-lose ORTS induction after liver transplantation. Methods. Sixteen patients received a 5- to 10-day course of OKTS (2.5 mg i.v. daily) along with azathioprine, prednisone, and the delayed introduction of cyclosporine (Neoral). Results. Patient and graft survival rates at 1 year were 88% and 82%. Five patients (31%) heal biopsyproven rejection; all five were treated successfully with steroids. There were 15 infections in 12 patients including 5 cytomegalovirus infections. Adverse events attributed to OKT3 consisted of low-grade fever (five patients), transient hypoxemia (three patients), and transient hypotension (two patients). Pharmacy aquisition costs for OKT3 averaged $ 2,139 less as compared to a group of historical controls receiving full-dose therapy. Conclusions. Low-dose OKT3 induction appears to be safe and useful method of postoperative immunosuppression after liver transplantation. Its ultimate clinical, immunologic, and ecomic effecacy awaits determination by randomized trial.
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