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A Randomized Prospective Trial of Acyclovir and Immune Globulin Prophylaxis in Liver Transplant Recipients Receiving OKT3 Therapy
Robert J. Stratta, MD;
Mark S. Shaefer, PharmD;
Kathleen A. Cushing, RN;
Rodney S. Markin, MD, PhD;
Elizabeth C. Reed, MD;
Alan N. Langnas, DO;
Todd J. Pillen, PA;
Byers W. Shaw, Jr, MD
Arch Surg. 1992;127(1):55-64.
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.
(Arch Surg. 1992;127:55-64)
Author Affiliations
From the Departments of Surgery (Drs Stratta, Langnas, and Shaw and Mr Pillen), Pharmacy Practice (Dr Shaefer and Ms Cushing), Pathology and Microbiology (Dr Markin), and Internal Medicine (Dr Reed), University of Nebraska Medical Center, Omaha.
Footnotes
Accepted for publication September 8, 1991.
Presented at the 11th Annual Meeting of the Surgical Infection Society, Fort Lauderdale, Fla, April 9, 1991.
Reprint requests to Department of Surgery, University of Nebraska Medical Center, 600 S 42nd St, Omaha, NE 68198-3280 (Dr Stratta).
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