Reversal of steroid- and anti-lymphocyte antibody-resistant rejection using intravenous immunoglobulin (IVIG) in renal transplant recipients.
BACKGROUND
Despite the recent advances in immunosuppression, steroid-resistant rejection remains a difficult problem in renal transplant recipients.


METHODS
We reviewed our experience with i.v. immunoglobulin (IVIG) in the treatment of steroid- and antilymphocyte antibody-resistant rejection in renal transplant patients. Between September 1996 and March 1999, 17 patients were treated with IVIG to reverse steroid- or antilymphocyte antibody-resistant rejection. A total of 2 g/kg of IVIG was administered to patients during each treatment course.


RESULTS
With a mean follow-up of 21.5+/-9.5 months from the time of IVIG administration, patient and graft survival rates were 94% (16/17) and 71% (12/17), respectively. The baseline mean serum creatinine level prior to rejection was 2.2+/-0.7 mg/dl and peaked at 3.3+/-1.1 mg/dl at the time of the diagnosis of refractory rejection. IVIG therapy was associated with a fall in the mean creatinine to 2.8+/-1.1 mg/dl. The most recent serum creatinine in patients with functioning grafts was 2.8+/-1.6 mg/dl. In 82% of allograft biopsies after IVIG, reversal or reduction in the severity of rejection was demonstrated. In addition, IVIG therapy rescued three of four patients with antilymphocyte antibody-resistant rejection.


CONCLUSIONS
IVIG rescue therapy for steroid- or antilymphocyte antibody-resistant rejection is associated with resolution or improvement of rejection severity, stable renal function, and reasonable graft survival.
Luke
P P
PP
Department of Urology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, 3601 Fifth Avenue, Pittsburgh, PA 15213, USA.
Scantlebury
V P
VP
Jordan
M L
ML
Vivas
C A
CA
Hakala
T R
TR
Jain
A
A
Somani
A
A
Fedorek
S
S
Randhawa
P
P
Shapiro
R
R
D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004351:Drug Resistance; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy; D013256:Steroids / Q000627:therapeutic use*
D000961:Antilymphocyte Serum; D016756:Immunoglobulins, Intravenous; D013256:Steroids; D003404:Creatinine