A Randomized Prospective Trial of Acyclovir and Immune Globulin Prophylaxis in Liver Transplant Recipients Receiving OKT3 Therapy

Robert J. Stratta, Mark S. Shaefer, Kathleen A. Cushing, Rodney S. Markin, Elizabeth C. Reed, Alan N. Langnas, Todd J. Pillen, Byers W. Shaw

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Abstract

The use of OKT3 therapy is a major risk factor for opportunistic infections in liver transplant recipients. In the last 2 years, we prospectively randomized 100 patients receiving OKT3 therapy into either a control group (n = 50) or a prophylaxis group (n=50). Prophylaxis consisted of six doses of intravenous immune globulin over 4 weeks and oral acyclovir for 3 months after OKT3 therapy. The two groups were comparable with respect to demographic, immunologic, and clinical characteristics. The regimen of prophylaxis resulted in (1) a significant reduction in the incidence of herpetic and Epstein-Barr viral infections; (2) no change in the incidence of cytomegalovirus infections; (3) a significant decrease in the incidence of fungal infections; and (4) fewer deaths due to sepsis. The incidence of viral and fungal infections was higher after OKT3 induction than after rescue therapy. Our conclusion is that opportunistic infections are frequent after OKT3 therapy in hepatic allograft recipients. Treatment with intravenous immune globulin and oral acyclovir is safe and effective in preventing noncytomegaloviral and fungal infections in this setting, thus conferring a survival advantage with fewer deaths due to sepsis.

Original languageEnglish (US)
Pages (from-to)55-64
Number of pages10
JournalArchives of Surgery
Volume127
Issue number1
DOIs
StatePublished - Jan 1992

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Muromonab-CD3
Acyclovir
Immunoglobulins
Mycoses
Liver
Intravenous Immunoglobulins
Incidence
Opportunistic Infections
Virus Diseases
Sepsis
Therapeutics
Cytomegalovirus Infections
Allografts
Transplant Recipients
Demography
Control Groups
Survival

ASJC Scopus subject areas

  • Surgery

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A Randomized Prospective Trial of Acyclovir and Immune Globulin Prophylaxis in Liver Transplant Recipients Receiving OKT3 Therapy. / Stratta, Robert J.; Shaefer, Mark S.; Cushing, Kathleen A.; Markin, Rodney S.; Reed, Elizabeth C.; Langnas, Alan N.; Pillen, Todd J.; Shaw, Byers W.

In: Archives of Surgery, Vol. 127, No. 1, 01.1992, p. 55-64.

Research output: Contribution to journalArticle

Stratta, Robert J. ; Shaefer, Mark S. ; Cushing, Kathleen A. ; Markin, Rodney S. ; Reed, Elizabeth C. ; Langnas, Alan N. ; Pillen, Todd J. ; Shaw, Byers W. / A Randomized Prospective Trial of Acyclovir and Immune Globulin Prophylaxis in Liver Transplant Recipients Receiving OKT3 Therapy. In: Archives of Surgery. 1992 ; Vol. 127, No. 1. pp. 55-64.
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