Intravenous immunoglobulins and transplantation for patients with anti-HLA antibodies.
Transplantation for patients possessing allo-antibodies against HLA antigens can be delayed for years, and, once the graft has been transplanted, its survival is significantly reduced. We and others have shown that administration of intravenous immunoglobulins (IVIgs) can induce a profound and sustained decrease in the titres of the anti-HLA antibodies, thus greatly enhancing the chances of those patients to obtain a transplant. In a number of cases, pre-treatment sera contained anti-donor antibodies that disappeared after IVIg administration. A similar approach, combining plasmapheresis and low-dose IVIgs, has shown similar results and has been successfully applied to ABO-incompatible transplantations. Patient and graft survival are excellent, despite a rather high rate of rejections, most notably humoral ones. These protocols thus demonstrate that the presence of anti-donor antibody, once an absolute contra-indication to transplantation, can, nowadays, be considered as an immunological hurdle that can be managed through appropriate immunological manipulation.
Glotz
Denis
D
Department of Nephrology, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France. denis.glotz@egp.ap-hop-paris.fr
Antoine
Corinne
C
Julia
Pierre
P
Pegaz-Fiornet
Béatrice
B
Duboust
Alain
A
Boudjeltia
Samir
S
Fraoui
Rabah
R
Combes
Myriam
M
Bariety
Jean
J
D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007114:Immunization; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007518:Isoantibodies / Q000032:analysis* / Q000276:immunology; D016377:Organ Transplantation; D014181:Transplantation Immunology
D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies