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Impact of OKT3 therapy on cytomegalovirus and herpes simplex virus infections after liver transplantation

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  • Medicine


ler proved to have (he three patients \Vall perhaps un ',erious side effects ,ive candida infect: '11 IOn IS I ustrated by the fa tents with no ong . ct OlOg hen the diagnosis . . Was dlons. We feel that the ! protocol are so gOOd Iy comparing Amph-e \mph-B prophylaXis' h. IS .lpS unet Ical. Instead le last month widened mph-B prophylaxis to .plant can~idates who .lr neomycIn treatment vma. 'i: t!ct of OKT3~~~~~n~~~~megalo'irus and Herpes Simplex Virus Infections After Liver Transplantation N. Singh, J.S. Dummer, S. Kusne, L. Makowka. T.E. Starzl, and M. Ho I NFECTION with the herpes group of viruses. in particular, cytomegalovirus (CMV), is a significant cause of morbidity and mortality in organ transplant recipients. Immunosuppressive regimens containing anti- thymocyte globulin (ATG) have been shown to be associated with a higher frequency of symptomatic CMV disease.' Another anti- lymphocyte preparation, OKT3, is a murine monoclonal antibody that has proved effica- cious in treating allograft rejection. The pur- pose of this study was to analyze the impact of OKT3 on the frequency and severity of CMV and herpes simplex virus (HSV) infections in adult liver transplant recipients. METHODS The study population consisted of 121 consecutive adult patients who underwent orthotopic liver transplan- tation at our institution between January 1984 and Sep- tember 1985, who survived for at least 72 hours postoper- alively, and for whom preoperative serum samples were available. Standard immunosuppression consisted of cyclosporine (CsA) and corticosteroids (20 mg/d ofpred- nisone). Rejection episodes were treated with additional steroids. Azathioprine (AzA) was usually administered to reduce the CsA dosage in patients experiencing nephro- toxicity. For more severe degrees of rejection OKT3 was administered. CMV infection was diagnosed by virus isolation or by changes in serological ti ter (seroconversion or a fourfold or greater rise CMV ant

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