Effect of high-dose intravenous immunoglobulin on anti-HLA antibodies in sensitized kidney transplant candidates.
Limited data exist on the effect of intravenous immunoglobulin (IVIg) on anti-HLA antibodies as determined by solid-phase assays. We reviewed our experience treating sensitized wait-listed kidney transplant recipients with IVIg as a method for desensitization and report our results utilizing Luminex single antigen (LSA) bead assay to quantify antibody reactivity (MFI). Fifteen patients with a cPRA > 40% received 2 g/kg IVIg per month for four months or until transplanted. LSA testing was performed before and after IVIg. Median MFI for anti-class I antibodies fell in 11 (73%) and increased in 4 (27%) patients after IVIg. Similar significant changes in MFI for anti-class II antibodies were observed in 10 patients (66%). Administration of IVIg was associated with a modest decrease in reactivity to both class I and II HLA antigens (median MFI change 493 and 1110, respectively; p < 0.0001) but did not significantly alter mean cPRA (85% before IVIg vs. 80% after IVIg; p = 0.1). Our data suggest a smaller effect of IVIg on HLA antibody reactivity than previously described, leading us to question how best to measure the efficacy of a desensitization protocol in current practice.
Division of Nephrology, Mount Sinai School of Medicine, New York, NY, USA. vinay.nair@mountsinai.org
Vinay
V
Nair
Deirdre
D
Sawinski
Enver
E
Akalin
Rex
R
Friedlander
Zeynep
Z
Ebcioglu
Vinita
V
Sehgal
Rajani
R
Dinavahi
Rafael
R
Khaim
Scott
S
Ames
Susan
S
Lerner
Barbara
B
Murphy
Jonathan S
JS
Bromberg
Peter S
PS
Heeger
Bernd
B
Schröppel
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003888:Desensitization, Immunologic; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy*; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D019172:Transplantation Conditioning; D014850:Waiting Lists
D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007518:Isoantibodies