What is the role of muromonab-CD3 (OKT3) in immunosuppression after solid organ transplantation?

Updated: Mar 01, 2021
  • Author: Bethany Pellegrino, MD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Murine monoclonal anti-CD3 antibody (muromonab-CD3)

Muromonab-CD3 (OKT3) is a murine monoclonal antibody of immunoglobulin 2A clones to the CD3 portion of the T-cell receptor. It blocks T-cell function and has limited reactions with other tissues or cells. This agent is used for induction and acute rejection (primary treatment or steroid-resistant). Soon after muromonab-CD3 administration, T cells disappear from the circulation as a result of opsonization and subsequent removal by the reticuloendothelial system.

Adverse effects include cytokine release syndrome (ie, fever, dyspnea, wheezes, headache, hypotension) and pulmonary edema. Avoiding administration in hypervolemic patients is especially important, although pulmonary edema can occur in euvolemic patients. This therapy requires premedication with steroids (first 2 doses only), acetaminophen, and diphenhydramine to avoid cytokine release syndrome. Its effects of therapy can be monitored by using a CD3 antigen assay.

Muromonab-CD3 is immunogenic in humans, and approximately 50% of patients make antibodies to it after a course of treatment, decreasing the efficacy of subsequent courses.

Post transplantation lymphoproliferative disorders have been reported after muromonab-CD3 administration.

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