Posttransplant prophylactic intravenous immunoglobulin in kidney transplant patients at high immunological risk: a pilot study

Am J Transplant. 2007 May;7(5):1185-92. doi: 10.1111/j.1600-6143.2007.01752.x. Epub 2007 Mar 12.

Abstract

The effects of posttransplant prophylactic intravenous immunoglobulin (IVIg) were investigated in renal transplant recipients at high immunological risk. Thirty-eight deceased-donor kidney transplant recipients with previous positive complement-dependent cytotoxicity crossmatch (n=30), and/or donor-specific anti-HLA antibodies (n=14) were recruited. IVIg (2 g/kg) was administrated on days 0, 21, 42 and 63 with quadruple immunosuppression. Biopsy-proven acute cellular and humoral rejection rates at month 12 were 18% and 10%, respectively. Glomerulitis was observed in 31% and 60% of patients at months 3 and 12, respectively, while allograft glomerulopathy rose from 3% at month 3 to 28% at 12 months. Interstitial fibrosis/tubular atrophy increased from 18% at day 0 to 51% and 72% at months 3 and 12 (p<0.0001). GFR was 50 +/- 17 mL/min/1.73 m(2) and 48 +/- 17 mL/min/1.73 m(2) at 3 and 12 months. PRA decreased significantly after IVIg (class I: from 18 +/- 27% to 5 +/- 12%, p<0.01; class II: from 25 +/- 30% to 7 +/- 16%, p<0.001). Patient and graft survival were 97% and 95%, respectively and no graft was lost due to rejection (mean follow-up 25 months). In conclusion, prophylactic IVIg in high-immunological risk patients is associated with good one-year outcomes, with adequate GFR and a profound decrease in PRA level, but a significant increase in allograft nephropathy.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Dose-Response Relationship, Drug
  • Female
  • Graft Rejection / immunology*
  • Graft Rejection / prevention & control*
  • Humans
  • Immunoglobulins, Intravenous / adverse effects
  • Immunoglobulins, Intravenous / immunology
  • Immunoglobulins, Intravenous / therapeutic use*
  • Immunologic Factors / adverse effects
  • Immunologic Factors / immunology
  • Immunologic Factors / therapeutic use*
  • Immunosuppression
  • Kidney / pathology
  • Kidney / physiology
  • Kidney Transplantation / immunology*
  • Male
  • Middle Aged
  • Pilot Projects
  • Risk Factors
  • Transplantation, Homologous
  • Treatment Outcome

Substances

  • Immunoglobulins, Intravenous
  • Immunologic Factors