The hemodynamic effects of intraoperative injection of muromonab CD3.

During anesthesia 5 mg of muromonab CD3 (OKT3), an anti-CD3 monoclonal antibody, was administered prophylactically to twelve patients undergoing cadaveric renal transplantation. Preoperatively, all patients were at or near their dry body weights. Methylprednisolone 500 mg on call to or in the operating room, azathioprine 2 mg kg-1 and diphenhydramine 50 mg were administered intraoperatively to reduce the probability and severity of reported effects of OKT3. After induction of anesthesia, the patients were monitored for changes in cardiovascular variables for up to 120 min after OKT3 administration. All patients had uneventful anesthetic courses. Analysis of variance showed no significant changes from pre-OKT3 administration in heart rate, mean blood pressure, mean pulmonary artery pressure, central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance (PVRI). CVP values were a reliable indicator of PCWP with the correlation coefficient of CVP to PCWP or r = 0.78 (P < 0.00005) and PCWP = .89 x CVP + 3.78. Cardiac index (CI) increased 22% at 105 min (P < 0.05). Systemic vascular resistance index (SVRI) decreased 21% at 105 min (P < 0.05). SVRI was increased 16% at 10 min post-OKT3 (P < 0.05). All of these statistically significant values were within acceptable clinical limits. Euvolemic cadaveric renal transplant recipients receiving prophylactic steroids and diphenhydramine may receive OKT3 in the operating room for induction immunosuppression without any appreciable risk of cardiovascular compromise.