Posttransplant prophylactic intravenous immunoglobulin in kidney transplant patients at high immunological risk: a pilot study.
The effects of posttransplant prophylactic intravenous immunoglobulin (IVIg) were investigated in renal transplant recipients at high immunological risk. Thirty-eight deceased-donor kidney transplant recipients with previous positive complement-dependent cytotoxicity crossmatch (n=30), and/or donor-specific anti-HLA antibodies (n=14) were recruited. IVIg (2 g/kg) was administrated on days 0, 21, 42 and 63 with quadruple immunosuppression. Biopsy-proven acute cellular and humoral rejection rates at month 12 were 18% and 10%, respectively. Glomerulitis was observed in 31% and 60% of patients at months 3 and 12, respectively, while allograft glomerulopathy rose from 3% at month 3 to 28% at 12 months. Interstitial fibrosis/tubular atrophy increased from 18% at day 0 to 51% and 72% at months 3 and 12 (p<0.0001). GFR was 50 +/- 17 mL/min/1.73 m(2) and 48 +/- 17 mL/min/1.73 m(2) at 3 and 12 months. PRA decreased significantly after IVIg (class I: from 18 +/- 27% to 5 +/- 12%, p<0.01; class II: from 25 +/- 30% to 7 +/- 16%, p<0.001). Patient and graft survival were 97% and 95%, respectively and no graft was lost due to rejection (mean follow-up 25 months). In conclusion, prophylactic IVIg in high-immunological risk patients is associated with good one-year outcomes, with adequate GFR and a profound decrease in PRA level, but a significant increase in allograft nephropathy.
Anglicheau
D
D
Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP, Paris, F-75015 France. dany.anglicheau@nck.aphp.fr
Loupy
A
A
Suberbielle
C
C
Zuber
J
J
Patey
N
N
Noël
L-H
LH
Cavalcanti
R
R
Le Quintrec
M
M
Audat
F
F
Méjean
A
A
Martinez
F
F
Mamzer-Bruneel
M-F
MF
Thervet
E
E
Legendre
C
C
D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D007165:Immunosuppression Therapy; D007668:Kidney / Q000473:pathology / Q000502:physiology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012307:Risk Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors