***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Between August 1986 and December 1987 , 88 patients received either RATG or OKT3 for immunoprophylaxis before heart transplantation . By the end of the first month after transplantation , 25 % of the patients who received RATG had experienced a rejection episode compared with 43 % of those receiving OKT3 . This difference was persistent as many as 4 months after transplantation . While 50 % of the OKT3 patients had a second episode of rejection , only 35 % of the RATG patients did so . R and omization of these agents was complicated by severe cardiopulmonary side effects attributed to the first dose of OKT3 . Five hours after the first dose of OKT3 , a 25 % drop in mean arterial pressure , accompanied by significant hypoxia , was seen in a majority of patients . There was no difference in the incidence of infection between the two groups We compared an equine antithymocyte globulin (ATGAM)-based protocol with a Minnesota antilymphocyte globulin (MALG)-based protocol and a murine monoclonal CD-3 (OKT-)-based protocol in 3 groups of heart transplant ( HT ) recipients . Thirty-four recipients received a four-day course of ATGAM . Thirty HT recipients received a 14-day course of OKT3 .  Fifteen HT recipients received MALG for an average of 10 days . The ATGAM group received cyclosporine beginning preoperatively , while the OKT3 and MALG groups received CyA beginning on post-transplant day 4 . All three groups received identical azathioprine and similar steroid therapy . The 3 groups were similar in age , donor/recipient HLA mismatches , and donor/recipient gender mismatches . The MALG and OKT3 groups had 20 % and 17 % females , respectively , while the ATG group had 41 % ( p < 0.05 ) . Average follow-up exceeded 14 months for each group . The ATGAM group received a higher dose of CyA during " induction " therapy than the OKT3 and MALG groups , and experienced a greater rise in post-transplant serum creatinine levels . We found no difference between the 3 groups in : preoperative creatinine levels , one-year post-transplant creatinine levels , number of patients who could be successfully " weaned " from steroids , or one-year survival . Other data are tabulated as episodes/patient : [ table : see text ] We conclude that ATG plus preoperative CyA is superior for rejection prophylaxis following heart transplantation when compared with either MALG plus postoperative CyA or OKT3 plus postoperative OKT3 is often used routinely for induction immunotherapy or selectively to avoid acute cyclosporine nephrotoxicity in heart transplant recipients at high risk for immediate postoperative kidney failure . It has not been shown in a r and omized trial to be useful in patients at low risk for early kidney failure . We r and omized 30 patients with a serum creatinine level of less than 1.4 mg/dl before heart transplantation to be treated with triple-drug immunotherapy with cyclosporine ,  which was started before surgery , ( group 1 ) or to be treated with OKT3 for 4 to 6 days after surgery with oral cyclosporine  , which was started between days 2 and 4 , after renal function had stabilized ( group 2 ) . Follow-up for 6 months revealed no significant differences in the total number of rejection episodes , total number of infections , or in the serum creatinine level . Four patients in group 1 and five patients in group 2 have had no rejection . OKT3 showed a trend to delay time to first rejection ( p = 0.10 ) , as has been reported for the 14-day induction course of OKT3 . A short course of OKT3 induction in heart transplant recipients at low risk for immediate postoperative kidney failure prolongs the time to first rejection for most patients but does not appear to reduce the total incidence of rejection in the first 6 months after heart transplantation The aim of this study was to compare the efficacy and toxicity of prophylactic OKT3 and equine antithymo-cyte globulin when each drug was administered for a similar duration after heart transplantation . Forty-one patients ( 35 males , 6 females ; mean age 46±2 years ) were r and omized to receive either OKT3 for 10 days ( 20 patients ) commencing within 24–48 hr of transplantation or ATGAM for 8 days ( 21 patients ) commencing on the day of transplantation . All patients were maintained on triple-agent immunosuppression with prednisolone , azathioprine , and cyclosporine . The two groups were well matched with respect to age , sex distribution , pretransplant cardiac diagnosis , and donor heart ischemic time . Mean duration of follow-up was 14 months ( range 9–19 months ) : Actuarial survival at 12 months was 83±9 in the OKT3 group and 81±9 in the ATG group ( P = NS ) . Mean time to first cardiac rejection was 33±8 days in the OKT3 group compared with 27± 5 days in the ATG group ( P = NS ) . Linearized rejection rate did not differ between the two groups at any time point up to 12 months posttransplant . Viral infections were significantly more common in the OKT3 group : 1.6±0.3 vs. 0.8±0.2 infections per patient ( P<0.05 ) . Adverse reactions were more common in patients who received OKT3 prophylaxis and included three patients who developed acute respiratory distress , two of whom required assisted ventilation . In conclusion , prophylactic OKT3 and ATGAM result in comparable rejection rates and survival when administered for a similar duration after cardiac transplantation . OKT3 , however , is associated with increased morbidity due to a higher incidence of adverse reactions and of viral infections Thirty-nine heart transplant recipients were r and omized prospect ively to receive OKT3 or antilymphoblast globulin ( ALG ) for 7 days , having otherwise identical protocol s ( group 1 : OKT3 , n = 20 patients ; group 2 : ALG , n = 19 patients ) . No preoperative immunosuppression was given . The protocol consisted of methylprednisolone , 500 mg intraoperatively , followed by 1 mg/kg/day , intravenously or orally , tapering to 0.2 mg/kg/day at 1 month ; oral cyclosporine starting 3 to 5 days after transplantation ; selective use of azathioprine , 1 to 4 mg/kg/day ; and either OKT3 , 5 mg/day for 7 days , or ALG , 15 mg/kg/day for 7 days . Of the 39 patients in the study , 34 are alive 6 months to 2 years after transplantation . The actuarial survival at 2 years for the OKT3 and ALG groups was 92 % ( + /- 0.07 % ) and 83 % ( + /- 0.09 % ) , respectively ( not significant [ NS ] ) . The time to first rejection for group 1 was 5.6 weeks and for group 2 was 5.3 weeks ( NS ) . The mean number of rejections for group 1 and group 2 was 2.1 episodes per patient and 1.4 per patient , respectively ( NS ) . Three patients in each group were free of rejection at 6 months . The total number of infections at 6 months was 1.05 per patient in group 1 , 0.74 per patient in group 2 ( NS ) , with 35 % of patients receiving OKT3 and 52 % of patients receiving ALG actuarially free of infection by 6 months after surgery ( NS ) . During the first 24 hours after surgery , no significant differences were noted in mean blood pressure , central venous pressure , or Po2 between the groups . ( ABSTRACT TRUNCATED AT 250 WORDS To compare monoclonal anti-T3-receptor antibody ( OKT3 ) and horse antithymocyte globulin ( HATG ) immunoprophylaxis , 23 heart transplant recipients were r and omized to OKT3 ( N = 12 ) 5 mg IV x 14 days of HATG ( N = 11 ) 5 mg/kg IV x 10 days and followed up for 216 + /- 137 days receiving triple immunosuppression . Recipient groups were demographically and clinical ly similar . First rejection occurred later in OKT3 recipients vs HATG recipients ( 31.7 + /- 18.3 vs 15.1 + /- 2.3 days ; p less than 0.01 ) , but the first rejection necessitating intensified immunosuppression occurred at similar times ( 30.9 + /- 14.6 vs 21.9 + /- 10.2 days ; NS ) . Phenotypic characterization of peripheral blood lymphocytes by flow cytometry revealed that OKT3 and HATG recipients had similar decreases in total T lymphocytes and lymphocyte sub population s. During the follow-up period rejection rates in the OKT3- and in the HATG-treated patients were 3.4 + /- 2.7 and 5.9 + /- 4.7 , respectively ( NS ) . The number of rejection episodes per recipient treated with intensified immunosuppression was 1.4 + /- 1.2 in the OKT3- and 2.0 + /- 3.1 in the HATG-treated patients ( NS ) . Infection rates were 4.9 + /- 5.2 in the OKT3- and 2.7 + /- 1.7 in the HATG-treated patients ( NS ) . The number of infection episodes that necessitated intravenous antimicrobial therapy was 2.7 + /- 2.3 in the OKT3- and 1.6 + /- 1.3 in the HATG-treated recipients ( NS ) . The number and length of hospitalizations were similar in patients given OKT3-based or HATG-based immunoprophylaxis . We conclude that immunosuppressive prophylaxis with OKT3 vs HATG in heart transplant recipients is associated with a slightly lower incidence and severity of rejection and slightly higher infection rates The value of immunoprophylaxis with monoclonal anti-CD3 antibodies ( OKT3 ) was evaluated in 44 consecutive , nonr and omized heart transplant patients . The control group ( n = 22 ) was treated with polyclonal rabbit antithymocyte globulin ( RATG ) for 5 days . The study group ( n = 22 ) was treated with OKT3 for 14 days . All patients had identical perioperative immunosuppressive therapy and similar maintenance therapy , with cyclosporine , azathioprine , and low-dose prednisone ( starting prednisone : OKT3 group immediately , RATG group 3 weeks [ n = 11 ] or greater than 3 months [ n = 11 ] after transplantation ) . The mean histologic rejection grade ( Texas classification ) in the RATG and the OKT3 groups was 2.5 + /- 1.9 and 0.6 + /- 0.8 ( p less than 0.005 ) after 1 week and 4.3 + /- 1.6 and 2.0 + /- 1.5 ( p less than 0.001 ) after 2 weeks , but there was no difference in the first year . The linearized rejection rate ( rejections per 100 patient days ) was higher in the RATG group in the first 2 weeks ( 2.6 vs 0 , p less than 0.05 respectively , 7.8 vs 0.7 , p less than 0.001 ) and higher in the OKT3 group in the second month ( 1.4 vs 2.8 , p less than 0.01 ) . In the RATG group the rejection rate fell continuously , to 0.1 at the end of the first year , whereas in the OKT3 group it remained 0.4 ( NS ) . The cumulative first-year incidence was similar for persistent rejections ( RATG 0.38 + /- 0.29 vs OKT3 0.48 + /- 1.13 , NS ) and insignificantly higher for severe rejections in the OKT3 group ( RATG 0.21 + /- 0.32 vs OKT3 0.49 + /- 1.10 ) . Rejection-related mortality in the first year was 0 % ( RATG ) and 9 % ( OKT3 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Recent studies comparing the effects of induction therapy with polyclonal antilymphocyte globulins ( ALG ) or with monoclonal T-cell-specific antibodies are not unanimous . Therefore , 55 heart recipients were allocated to either 7-day courses of polyclonal ALG ( n = 28 ) or of monoclonal OKT3 ( n = 27 ) . Additionally , azathioprine and low dose steroids were given . There were no severe side effects after OKT3 ; the course of ALG , however , had to be discontinued in 20 patients because of extensive flares . No differences between the two groups were found in freedom from rejection or in the incidence of infection . The 1- and 2-year survival was 96 % in both groups . Although monoclonal and polyclonal induction therapies are equally effective for rejection prophylaxis , OKT3 may be preferred because of a lack of important side effects . However , the fact that a shorter course of ALG is equally effective may be in favour of ALG A r and omized trial of RATG ( polyclonal ) vs. OKT3 ( monoclonal ) antibody prophylaxis was carried out in 82 cardiac transplant recipients 
    Output:
    
A greater number of drug related side-effects was observed , however , in the monoclonal group , including episodes of acute pulmonary edema and hypotension .
The increased rate of side-effects with monoclonal antibodies might suggest a superiority of polyclonal over monoclonal antibodies