title: Immunoglobulin prolongs survival of pig kidneys perfused ex vivo with human blood.
abstract: Intravenous immunoglobulin (IVIG) (Octagam), was used to determine the effect on hyperacute rejection in an ex vivo xenograft model. Six pig kidneys were perfused with IVIG and fresh human AB blood, and six control pig kidneys were simultaneously perfused with albumin and blood from the same donation. The survival of the IVIG-perfused xenografts (median, 6.5 h) was significantly (P = 0.03) longer than the albumin-perfused xenografts (median, 3.5 h). Complement was activated in both groups. The administration of IVIG to the perfused blood resulted in immediate and significantly higher complement activation in the fluid phase as compared with the albumin group. At rejection the fluid phase complement activation was higher in the IVIG group than in the albumin group for C1rs/C1inh complexes, C4bc, Bb and TCC. At the time of rejection both the albumin and the IVIG group demonstrated interstitial tubular haemorrhage, vasculitis or necrosis of glomerular capillaries and glomerular microthrombi. IgM, C1q, C3c, C4 and fibrin were located in arteries and glomeruli and IgG in the interstitium in both groups at rejection. The fluid phase findings are consistent with a modulatory effect of IVIG on complement activation by deviating the classical pathway activation towards the fluid phase. The prolonged survival of the IVIG-perfused kidneys suggests that IVIG may be useful to dampen hyperacute rejection.
authors.affiliation: Department of Surgery A, University of Oslo, The National Hospital, Norway.
authors.forename: A E
authors.initials: AE
authors.lastname: Fiane
authors.forename: V
authors.initials: V
authors.lastname: Videm
authors.forename: O J
authors.initials: OJ
authors.lastname: Mellbye
authors.forename: A
authors.initials: A
authors.lastname: Foerster
authors.forename: O R
authors.initials: OR
authors.lastname: Geiran
authors.forename: I P
authors.initials: IP
authors.lastname: Gladhaug
authors.forename: J L
authors.initials: JL
authors.lastname: Svennevig
authors.forename: T E
authors.initials: TE
authors.lastname: Mollnes
mesh_terms: D000818:Animals; D001769:Blood; D003167:Complement Activation; D015923:Complement C1r / Q000378:metabolism; D003173:Complement C1s / Q000378:metabolism; D051561:Complement C3 Convertase, Alternative Pathway; D003179:Complement C3b / Q000378:metabolism; D015935:Complement C4b / Q000378:metabolism; D005260:Female; D006085:Graft Survival; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000494:pharmacology*; D066298:In Vitro Techniques; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008954:Models, Biological; D010446:Peptide Fragments / Q000378:metabolism; D010477:Perfusion; D013552:Swine; D014183:Transplantation, Heterologous
chemical_list: D016756:Immunoglobulins, Intravenous; D010446:Peptide Fragments; D003179:Complement C3b; D015935:Complement C4b; D015923:Complement C1r; D003173:Complement C1s; D051561:Complement C3 Convertase, Alternative Pathway