title: IgM-Enriched Human Intravenous Immunoglobulin-Based Treatment of Patients With Early Donor Specific Anti-HLA Antibodies After Lung Transplantation.
abstract: BACKGROUND
  At our institution, until April 2013, patients who showed early donor specific anti-HLA antibodies (DSA) after lung transplantation were preemptively treated with therapeutic plasma exchange (tPE) and a single dose of Rituximab. In April 2013, we moved to a therapy based on IgM-enriched human immunoglobulins (IVIG), repeated every 4 weeks, and a single dose of Rituximab.
  
  
  METHODS
  This observational study was designed to evaluate the short-term patient and graft survival in patients who underwent IVIG-based DSA treatment (group A, n = 57) versus contemporary patients transplanted between April 2013 and January 2015 without DSA (group C, n = 180), as well as to evaluate DSA clearance in IVIG-treated patients versus historic patients who had undergone tPE-based treatment (group B, n = 56). Patient records were retrospectively reviewed. Follow-up ended on April 1, 2015.
  
  
  RESULTS
  At 6 months and 1 year of follow-up, group A had a survival similar to group C (P = 0.81) but better than group B (P = 0.008). Group A showed statistically nonsignificant trends toward improved freedom from pulsed-steroid therapy and biopsy-confirmed rejection over groups B and C. The DSA clearance was better in group A than group B at treatment end (92% vs 64%; P = 0.002) and last DSA control (90% vs 75%; P = 0.04).
  
  
  CONCLUSIONS
  Patients with new early DSA but without graft dysfunction that are treated with IVIG and Rituximab have similarly good early survival as contemporary lung transplant recipients without early DSA. The IVIG yielded increased DSA clearance compared with historic tPE-based treatment, yet spontaneous clearance of new DSA also remains common.
authors.affiliation: 1 Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.2 Department of Transfusion Medicine, Hanover Medical School, Hanover, Germany.3 Department of Hypertension and Nephrology, Hanover Medical School, Hanover, Germany.4 Division of Patient Care, Hanover Medical School, Hanover, Germany.5 Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany.6 Department of Paediatric Pneumology, Hanover Medical School, Hanover, Germany.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ius
authors.forename: Wiebke
authors.initials: W
authors.lastname: Sommer
authors.forename: Daniela
authors.initials: D
authors.lastname: Kieneke
authors.forename: Igor
authors.initials: I
authors.lastname: Tudorache
authors.forename: Christian
authors.initials: C
authors.lastname: Kühn
authors.forename: Murat
authors.initials: M
authors.lastname: Avsar
authors.forename: Thierry
authors.initials: T
authors.lastname: Siemeni
authors.forename: Jawad
authors.initials: J
authors.lastname: Salman
authors.forename: Carolin
authors.initials: C
authors.lastname: Erdfelder
authors.forename: Murielle
authors.initials: M
authors.lastname: Verboom
authors.forename: Jan
authors.initials: J
authors.lastname: Kielstein
authors.forename: Andreas
authors.initials: A
authors.lastname: Tecklenburg
authors.forename: Mark
authors.initials: M
authors.lastname: Greer
authors.forename: Michael
authors.initials: M
authors.lastname: Hallensleben
authors.forename: Rainer
authors.initials: R
authors.lastname: Blasczyk
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Schwerk
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007075:Immunoglobulin M / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D007075:Immunoglobulin M; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab