A randomized prospective trial of acyclovir and immune globulin prophylaxis in liver transplant recipients receiving OKT3 therapy
R. J. Stratta, M. S. Shaefer, K. A. Cushing, R. S. Markin, E. C. Reed, A. N. Langnas, T. J. Pillen and B. W. Shaw Jr
Department of Surgery, University of Nebraska Medical Center 68198-3280.
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 non-cytomegaloviral and fungal infections in this setting, thus
conferring a survival advantage with fewer deaths due to sepsis.
