Immunologic monitoring during OKT3 intervention in cyclosporine-treated renal allograft recipients

When patients are treated with OKT3, the immediate effect is removal of circulating T cells and reversal of rejection. As T cells recover from this treatment and begin to repopulate the peripheral circulation, relative levels of helper and suppressor/cytotoxic cells, as measured by the OKT4/OKT8 ratio, may be indicative of the future outcome of the graft. This repopulation situation, which occurs only with complete removal of circulating T cells by monoclonal antibody, is different from the complex immune status of allograft recipients at other times. In this current study, repopulation with normal (>1.2) ratios carried a good prognosis for successful graft outcome. On the other hand, repopulation with a low ratio indicated that re-rejection could result in graft failure. Treatment of cyclosporine-treated recipients with OKT3 can be beneficial in clarifying the nature of graft dysfunction. In addition, such treatment may provide insight into the immunobiology of the allograft response.