Pretransplant immunomodulation of highly sensitized small bowel transplant candidates with intravenous immune globulin.
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.
Gondolesi
Gabriel
G
Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. gabriel.gondolesi@msnyuhealth.org
Blondeau
Benoit
B
Maurette
Raphael
R
Hoppenhauer
Laura
L
Rodriguez-Laiz
Gonzalo
G
Schiano
Thomas
T
Boros
Peter
P
Bromberg
Jonathan
J
Akalin
Enver
E
Sauter
Bernhard
B
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
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors