Central Nervous System Complications from Multiple Courses of the Monoclonal Antibbody Muromonab-CD3 (OKT3) Therapy: a Case Report

Main Article Content

Kulruedee Wongbenjarat

Abstract

This case report was a 17-year-old Austian boy who had undergone 3 episodes of cadavenic renal transplantations which complicated by two episodes of centtal nervous system adverse effects from the monoclonal antibody muromonab-CD3 (OKT3) during his first and third operation. The duration between the two reactions was 8 years

Article Details

How to Cite
Wongbenjarat, K. (2025). Central Nervous System Complications from Multiple Courses of the Monoclonal Antibbody Muromonab-CD3 (OKT3) Therapy: a Case Report. Maharat Nakhon Ratchasima Hospital Journal, 23(1), 39–48. retrieved from https://he04.tci-thaijo.org/index.php/MNRHJ/article/view/2577
Section
Case Report

References

Cosimi AB, Burton RC, Colvin RB, et al Treatment of acute renal allograft rejection with OKT3 monoclonal antibody. Transplantation 1981;32:535-9.

Orthomulticenter transplant study group. A randomized clinical trial of OKT3 monoclonal antibody for acute rejection of cadaveric renal transplants. N Engl J Med 1985;313:337-42.

Abramomicz D, Schandenne L, Golman M, et al. Release of tumor necrosis factor, interleukin 2, and gamma-inter-feron in serum after injection of OKT3 monoclonal antibody in kidney transplant recipients. Transplantation 1989;47:606.

Sgro C. Side effects of a mooclonal antibody, muromonab CD3 (orthoclone OKT3): bibliographic review. Toxicology 1995;105:23-9.

Takahashi K. Muromonab CD3 (orthoclone OKT3). J Toxicol Jci 1995;20:483-4.

Gaston RS, Deierboi MH, Patterson T3, et al. OKT3 fist dose reaction: association with T cell subsets and cytokine release. Kidney Int 1991;39:141-8.

Jeyarajah Dr, Thistlethwaite Jr. General aspects of cytokine release syndrome: timing and incidence (review). Transplant Proc 1993;25(2 suppl 1):16-20.

Bloemenatenberge IJM, Surachno J. Kinetics of IL-6 during OKT3 therapy in renal allograft recipients. Transplantation 1990;50:330-1.

Vasquez EM, Fabrega AJ, Pollak R. OKT3 induced cytokine-release syndrome: occurrence beyond the second dose and association with rejection severity. Transplant Proc 1995;27:873-4.

Thistlethwaite JR, Cosimi AB, Delmonico FL, et al. Evolving use of OKT3 monoclonal antibody for treatment of renal allograft rejection. Transplantation 1984;38:695-701.

Thistlethwaiste JR, Stuart JR, Mayes JT, et al. Compications and monitoring of OKT3, therapy. Am J Kidney Dis 1988;11:112-9.

Emmons C, Smith J, Flanigan M. Cerebrospinal fluid inflammation during OKT3 therapy [letter]. Lancet 1986;2:510-1.

Roden J, Klintmalm GB, Husberg BS, et al. Cerebrospinal fluid inflammation during OKT therapy. Lancet 1987;2:272.

Chan GL, Weinstein SS, Wright CE, et al. Encephalopathy associated with OKT3 administration. Transplantation 1991;52:148-50.

Reiss R, Makoff D, Rodriguez H, et al. Encephalopathy and cerebral infarction in OKT3 treated patients with elevation of cerebrospinal fluid tumor necrosis factor ∂. Nephrol Dial Transplant 1993;8:464-8.

Min DI, Fallo SA. Encephalopathy associated with muromonab-CD3 Clin Pharm 1993;12:610-2.

Shihab FS, Barry JM, Norman DJ.Encephalopathy following the use of OKT3 in renal allograft transplantation. Transplant Proc 1993;25(suppl 1):31-4.

Shihab FS, Barry JM, Bennett WM, et al. Cytokine-related encephalopathy induced by OKT3: incidence and predisposing factors. Transplant Proc 1993;25:564-5.

Martin MA, Massanari M, Nghiem DD, et al. Nosocomial aseptic meningitis associated with administration of OKT3. JAMA 1988;259:2002-5.

Coleman AE, Norman DJ. OKT3 encephalopathy. Ann Neurol 1990;28:837-8.

Werier J. Anaphylactic hypersensitivity reaction after repeat OKT3 treatment. Lancet 1991;337:1351.

Kehinde EO, Feehally J, Scriven SD. Treatment of steroid resistant rejection following renal transplantation: benefits and risks of OKT3 Transplant Proc 1996;28:1449-50.

Bemelman FJ, Buysmann S, Surachno J,et al. Pretreatment with divided doses of steroids strongly decreases side effects of OKT3. Kidney Int 1994;46:1674-9.

Parlevliet KJ, Bemelman FJ, Yong SL, et al. Toxicity of OKT3 increases with dosage: a controlled study in renal transplant recipients. Transpl Int 1995;8:141-6.

Abramowicz D, De pauw L, LE Lemoine A. Prevention of OKT3 nephrotoxicity after kidney transplantation. Kidney Int 1996;53(suppl):39-43.

Osterman JD, Trauner DA, Reznik VM, et al. Transient hemiparesis associated with monoclonal CD3 antibody (OKT3)therapy. Pediatr Neurol 1993;9:482-4.

Agarwal RK, Ostaszewski ML,Fold LG, et al. Tumor necrosis factor and interleukin-6 in cerebrospinal fluid of a patient with recurrent adverse central nervous system events following OKT3 . Transplant Proc 1993:25:2143-4.

Capone PM, Cohen ME. Seizures and cerebritis associated with administration of OKT3. Pediatr Neurol 1991;7:299-301.

Norman DJ, Kimball JA, Barry JM. Cytokine release syndrome: differrences between high and low doses of OKT3. Transplant Proc 1993;25(suppl 1):35-8.

Radhakrishnan J, Cohen DJ. Cytokine release syndrome: general risk factors modification-reparation of high risk patients for use of OKT3. Transplant Proc 1993;25(suppl 1):60-2.

Freeman RG, Sheff MF, Maher JK, et al. The blood cere brospinal fluid barrier in uremia. Ann Intern Med 1962;56:233.

Kehinde EO, Scriven SD, Feehally J, et al. Adverse effects of OKT3 therapy: increased risk with impaired renal function. Transplant Proc 1994;26:1945-7.

Woodle ES, Bruce DS, Josephson M, et al. OKT3 eslating dose regimens provide effective therapy for renal allograft rejection. Clin Transpl 1996;10:389-5.

Piatosa B, Grenda R, Prokurat S. Prevention of the OKT3 first dose syndrome by reduced initial dose followed by adjusted doses based on CD3 T-lymphocyte counts in pediatric renal graft recipients. Transplant Proc 1996;28:3466-7.

Parlevliet KJ, Ten Berge RJ, Raasveld MH. et al. Low dose OKT3 induction therapy following renal transplantatation: a controlled study. Nephrol Dial Transplant 1994;9:698-703.

Vasquez EM, Pollak R. Effect of oral pentoxyfylline on the OKT3 -induced cytokine-release syndrome among renal allograft recipients. Clin Transplant 1996;10:294-7.

Brown M, Korb S, Light JA, et al. Low dose OKT3 induction therapy following renal transplantation lead improved graft function and decreased adverse effects. Transplant Proc 1993;25:553-5.

Eason JD, Pascual M, Wee S, et al. Evaluation of recombinant human soluble dimeric tumor necrosis factor receptor for prevention of OKT3 -associated acute clinical syndrome. Transplantation 1996;61:224-8.

Abbs IC, Clarr M, Waldmann H, et al. Sparing of first dose effect of monovalent anti CD3 antibody used in allograft rejection is associated with diminished release of proinflammatory cytokines. Ther Immunol 1994;1:325-31.

Kehinde EO, Veitch PS, Scriven SD, et al. Complications of using OKT3 for induction of immunosuppression in recipients of kidneys from non heart beating donors. Transplant Proc 1994;26:3123-6.

David I, Mina, Sally A, et al. Encephalopathy associated with muromonab-CD3. Clin Pharm 1993;12:610-2.

Jeffrey RF, Johnson MH, Bamford JM, et al. Prolonged neurological disability following OKT3 therapy for acute renal transplant rejection. Transplantation 1993;55:677-9

Saaron MB, Andrew JA, Eileen ES, et al. OKT3 induction in pediatric renal transplantation. Pediatr Nephrol 1993;7:45-9.

Madden RL, Schroeder TJ, Alexander JW, et al. Single dose OKT3 :adverse effects , pharmacokinetics, and antiOKT3, antibody response. Transpl Sci 1994;4:111-4.

Abramowicz D, Goldman M, Mat O, et al. OKT3, serum levels as a guide for prophylactic therapy: a pilot study in kidney transplant recipients. Transpl Int 1994:258-63.

Williams AF,Gagman J. Neuronal cell thy-1 glycoprotein: homology with immunoglobulin. Science 1982;216:696-703.

Charpenter B, Hiesse C, Ferran C, et al. Acute clinical syndrome associated with OKT3 administration prevention by single injection of an anti human TNF-Q monoclonal antibody. Presse Med 1991;20:2007.