Anti-CD3 and -CD4 monoclonal antibody in the treatment of steroid-resistant renal allograft rejection.

Between November 1987 and October 1991, 40 consecutive cadaveric renal recipients immunosuppressed with cyclosporine (CsA) who developed renal allograft rejection were treated with domestically prepared muromonab CD3 (Wu 338) and CD4 (Wu167). CD3 and CD4 monoclonal antibodies (McAb) as rescue treatment (n = 34) successfully reversed 29 cases of (85.3%) intractable renal allograft rejection (steroid resistant rejection 32 and anti-human thymocyte globulin [AHTG] resistant rejection 2) and completely reversed 4 cases of acute renal rejection episodes CD3 McAb as first-line treatment (n = 4). Two cases of chronic rejection failed in the treatment of McAb. Rejection episodes were reversed from 4 to 11 days (mean 6 days). Combined use of CD3 and CD4 McAb seemed to yield better results. Peripheral blood T lymphocyte subsets showed that CD3+, CD4+ and CD8+ decreased significantly after the treatment of McAb. No severe side-effects were observed in the treatment of McAb. The McAb could be administered safely. Pulmonary infection rate was 15%. The yearly graft survival rate was increased significantly (87.8% vs 80.0%).