Long-term benefit of intravenous immunoglobulins in cadaveric kidney retransplantation.
Renal retransplantation can be hampered by the presence of anti-HLA alloantibodies. Previous studies have documented in vitro and in vivo suppression of these antibodies by intravenous immunoglobulins (IVIg). We conducted a randomized study in 41 patients, who have received a second cadaveric transplant between 1989 and 1994. They all were treated with a quadruple-immunosuppressive protocol. In addition, 21 patients received 0.4 g/kg/day of IVIg, on the first 5 days after transplantation. The two groups of patients were identical for age, sex, duration of the first graft, duration of cold ischemia, anti-HLA sensitization, HLA matching, the number of acute rejection episodes, and the incidence of cytomegalovirus infection. The 5-year survival rate was significantly higher in the group of patients treated with IVIg: 68% versus 50% in the control group. The only significant factor associated with IVIg infusion and better survival was a shorter delay of graft function (3.4 +/- 1.0 days versus 9.9 +/- 1.6 days). In conclusion, this randomized study demonstrates that IVIg treatment is associated with better long-term graft survival in retransplanted patients. This beneficial effect may be related to a long-lasting immunosuppressive effect of IVIg and/or to an early protective effect of the graft against ischemia.
Peraldi
M N
MN
Service de Néphrologie A, Hôpital Tenon, Paris, France.
Akposso
K
K
Haymann
J P
JP
Flahaut
A
A
Marlin
C
C
Rondeau
E
E
Sraer
J D
JD
D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis; D002102:Cadaver; D005260:Female; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology; D008134:Long-Term Care; D008297:Male; D012086:Reoperation; D015996:Survival Rate
D000888:Antibodies, Anti-Idiotypic; D016756:Immunoglobulins, Intravenous; C048844:anti-IgG