title: Pretransplant immunomodulation of highly sensitized small bowel transplant candidates with intravenous immune globulin.
abstract: Presence of preformed lymphocytotoxic antibodies may represent a barrier to isolated intestinal transplantation (IITx). We developed an intravenous immunoglobulins (IVIg) based desensitization protocol for candidates with high panel-reactive antibodies (PRA). Six patients with a mean PRA of 72+/-22% were included in a four-level (L) protocol with escalating doses of IVIg (L1, L2), addition of mycophenolate mofetil (MMF) or plasmapheresis (L3); and anti-CD20 (Rituximab) (L4). Four of six candidates improved their PRAs (from a mean of 66.2% to 25.5%; P=0.01) and were successfully transplanted. At a mean follow-up of 8 months, number and severity of rejection episodes of protocol patients did not differ from patients with low PRA transplanted during the same period. These data support the use of IVIg to desensitize patients waiting for IITx. It increases the applicability of IITx, and reduces the waiting time and mortality on the waiting list with outcomes comparable to nonsensitized recipients.
authors.affiliation: Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. gabriel.gondolesi@msnyuhealth.org
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gondolesi
authors.forename: Benoit
authors.initials: B
authors.lastname: Blondeau
authors.forename: Raphael
authors.initials: R
authors.lastname: Maurette
authors.forename: Laura
authors.initials: L
authors.lastname: Hoppenhauer
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Rodriguez-Laiz
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiano
authors.forename: Peter
authors.initials: P
authors.lastname: Boros
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bromberg
authors.forename: Enver
authors.initials: E
authors.lastname: Akalin
authors.forename: Bernhard
authors.initials: B
authors.lastname: Sauter
mesh_terms: D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000276:immunology / Q000494:pharmacology*; D007155:Immunologic Factors / Q000276:immunology / Q000494:pharmacology; D007421:Intestine, Small / Q000187:drug effects* / Q000276:immunology / Q000637:transplantation*; D008875:Middle Aged; D019172:Transplantation Conditioning
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors