Acute renal transplant injury and interaction between antithymocyte globulin and pooled human immunoglobulin.
The increasing number of highly sensitized patients awaiting renal transplantation has prompted the use of induction immunosuppression regimens including pooled human intravenous immunoglobulin (IVIG) combined with polyclonal anti-lymphocyte sera. We report a case of a patient who received a live donor transplant after abrogation of donor-specific positive cytotoxic crossmatch by IVIG. She developed early acute tubular injury associated with IVIG, mannitol, and hypertonic saline infusion. Furthermore, a possible interaction between IVIG and rabbit antithymocyte globulin (ATG) occurred, suggested by an increased number of peripheral CD3(+) lymphocytes after initial rapid lymphodepletion. We suggest that IVIG-associated nephrotoxicity should be considered in the differential diagnosis of early allograft dysfunction, and furthermore, that IVIG may interact with polyclonal antilymphocyte serum to affect the amount of lymphodepletion achieved.
Gallay
Brian J
BJ
Transplant Medicine Section, University of California, Davis Medical Center, Sacramento, CA, USA. brian.gallay@ucdmc.ucdavis.edu
Perez
Richard V
RV
Ramsamooj
Rajen
R
D000961:Antilymphocyte Serum / Q000009:adverse effects* / Q000276:immunology; D048909:Diabetes Complications; D004347:Drug Interactions / Q000276:immunology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects* / Q000276:immunology; D007674:Kidney Diseases / Q000139:chemically induced / Q000209:etiology* / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods; D019520:Living Donors; D008875:Middle Aged; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D016756:Immunoglobulins, Intravenous