title: Impact of pretransplant intravenous immunoglobulin administration on anti-AB0 antibody levels in AB0-incompatible living donor kidney transplantation.
abstract: BACKGROUND
  From March 2007 to July 2010, we performed 14 AB0-incompatible (AB0i) living kidney transplantations using donor blood group-specific immunoadsorption (IA), anti-CD20 monoclonal antibody, and intravenous immunoglobulin (IVIG) pretreatment.
  
  
  METHODS
  To analyze the effect of a presumed anti-donor blood group-specific antibody transfer by IVIG administration (0.5 g/kg; 5.4 ± 0.9 days pretransplant), we assessed AB0i antibody titers in different IVIG preparations and evaluated their impact on patient AB0i antibody titers.
  
  
  RESULTS
  AB0i antibody IgG titers before treatment ranged from 8 to 1024. We performed 6.9 ± 1.1 IA procedures pretransplant to reach AB0i antibody titers ≤4, which enabled successful transplantation in all pretreated patients. Their mean serum creatinine at discharge was 1.5 ± 0.1 mg/dL. IVIG preparations differed profoundly in their AB0i antibody titers: The lowest titers were observed in Sandoglobulin preparations (1-8) compared with Intratect (2-128), Octagam (4-32) and Gamunex (2-512). Usually, administration of the IVIG preparation containing the lowest isoagglutinin titer resulted in low AB0i antibody titer increments in patient sera: Sandoglobulin, 2 titer steps (n = 2), 1 titer step (n = 1), and 0 titer steps (n = 5). In contrast, Octagam showed 0 titer steps (n = 2) and Intratect, 0 titer steps (n = 3). However, after Gamunex administration, the AB0i antibody titer of 8 and the AB0i antibody titer rose 3 titer steps (16 to 128; n = 1), which could not be explained by passive transfer of isoagglutinin alone.
  
  
  CONCLUSIONS
  Our data showed that the choice of IVIG preparation with the lowest AB0i antibody levels is a time- and cost-sparing step in the pretreatment of AB0i living donor kidney recipients. Posttransplant, a high isoagglutinin content within the IVIG preparation has the potential to induce antibody-mediated rejection.
authors.affiliation: Department of Internal Medicine, Nephrology and Renal Transplantation, University of Giessen, Germany. fabrice.renner@innere.med.uni-giessen.de
authors.forename: F C
authors.initials: FC
authors.lastname: Renner
authors.forename: S
authors.initials: S
authors.lastname: Wienzek-Lischka
authors.forename: A
authors.initials: A
authors.lastname: Feustel
authors.forename: G
authors.initials: G
authors.lastname: Bein
authors.forename: W A
authors.initials: WA
authors.lastname: Stertmann
authors.forename: W
authors.initials: W
authors.lastname: Padberg
authors.forename: R
authors.initials: R
authors.lastname: Weimer
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000906:Antibodies / Q000097:blood*; D001787:Blood Group Incompatibility / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D016030:Kidney Transplantation; D019520:Living Donors
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies; D016756:Immunoglobulins, Intravenous