OKT3 for refractory rejection in lung transplantation is not associated with an increased risk for CMV disease

Purpose: Previous studies in other solid organ transplant populations suggest that profound cellular immunosuppression such as that associated with Orthoclone OKT3® predisposes patients to CMV disease. We reviewed the incidence of CMV disease in our lung transplant recipients treated with OKT3 for refractory rejection. Methods: 85 of 120 patients records were adequate for review. New CMV infection was defined as identification of the virus in any body fluid by culture or shell vial without evidence of cellular replication after OKT3 was initiated. New CMV disease was defined as lung tissue evidence of cellular viral replication by histopathology or immunohistochemical staining with or without symptoms after OKT3 was initiated. 11/85 patients with acute or chronic rejection that demonstrated biopsy evidence of ongoing rejection after two courses of parenteral solumedrol bursts two weeks apart were defined as having refractory rejection (RR). These patients received parenteral OKT3 (5mg/day 7-10 days) without CMV prophylaxis. Patients were surveyed for up to one year or to death (mean 4.7 ± 3 months). Results: CMV ^#OF RR NEW NEW STATUS PATIENTS INFECTION DISEASE R +/ D+ 6 2 1 R +/ D- 3 0 1 R -/ D- 2 0 0 R -/ D+ 0 0 0 TOTAL 11 2 2 Conclusions: 2/11 RR patients were spilling virus in body fluid(s) at the time OKT3 was initiated. A different 9/11 patients developed no new viral spillage. 2/11 RR patients developed new evidence of CMV disease one of which had spilled CMV at the time therapy was initiated. Clinical Implications: These data suggest that under the surveillance conditions specified above, OKT3 for refractory rejection does not significantly increase the risk for CMV infection or disease and CMV prophylaxis is unnecessary.