title: Renal safety of high-dose, sucrose-free intravenous immunoglobulin in kidney transplant recipients: an observational study.
abstract: High-dose intravenous immunoglobulin (IVIg) is commonly used during kidney transplantation. Its nephrotoxicity has been attributed to sucrose stabilizers. We evaluated the renal safety of newer formulations of sucrose-free IVIg. We retrospectively studied clinical and histological data from 75 kidney recipients receiving high-dose, sucrose-free IVIg courses. This group was compared with 75 matched kidney recipients not treated with IVIg. Sucrose-free IVIg treatment was not associated with any acute kidney injury episode at 3 months, but an increased frequency of tubular macrovacuoles (28% vs. 2.8%, P < 0.001) was observed. Among IVIg-treated patients, the presence of macrovacuoles at 3 months was associated with increased IF/TA scores at 3 months (1.7 ± 1 vs. 1 ± 1, P = 0.005) and was more often observed in kidneys with higher IF/TA scores on day 0 (0.6 ± 0.9 vs. 0.3 ± 0.8, P = 0.03) at 3 months. Finally, patients treated with amino-acid-stabilized formulations developed fewer macrovacuoles at 3 months (12% vs. 60%; P < 0.001) than those treated with carbohydrate-stabilized IVIg. Our study shows that high-dose, sucrose-free IVIg use in early kidney recipients is clinically well tolerated. Among sucrose-free IVIg, amino-acid-stabilized formulations are associated with less tubular toxicity than carbohydrate-stabilized IVIg.
authors.affiliation: Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France. yosu.luque@aphp.fr.|Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France;, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Paris, France. yosu.luque@aphp.fr.
authors.forename: Yosu
authors.identifier: http://orcid.org/0000-0002-3172-6571
authors.initials: Y
authors.lastname: Luque
authors.affiliation: Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.|Université Paris Descartes, Sorbonne Paris Cité, Paris, France.|Centaure Foundation and Labex Transplantex, Necker Hospital, Paris, France.
authors.forename: Dany
authors.initials: D
authors.lastname: Anglicheau
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France.|Anatomie et Cytologie Pathologiques, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Rabant
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France.|Service de Physiologie, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Khalil
authors.initials: K
authors.lastname: El Karoui
authors.affiliation: Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Jamme
authors.affiliation: Paris Translational Research Centre for Organ Transplantation, Inserm, UMR-S970, Paris Descartes University, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Aubert
authors.affiliation: Pharmacie, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Rozenn
authors.initials: R
authors.lastname: Clément
authors.affiliation: Anatomie et Cytologie Pathologiques, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Laure-Hélène
authors.initials: LH
authors.lastname: Noël
authors.affiliation: Division of Nephrology and Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montréal, QC, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bollée
authors.affiliation: Service de Néphrologie, Hôpital Foch, Suresnes, France.
authors.forename: Albane
authors.initials: A
authors.lastname: Brodin-Sartorius
authors.affiliation: Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Martinie
authors.affiliation: Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.|Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Kreis
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Paris, France.|Urologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Timsit
authors.affiliation: Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.|Université Paris Descartes, Sorbonne Paris Cité, Paris, France.|Centaure Foundation and Labex Transplantex, Necker Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002241:Carbohydrates; D005260:Female; D006084:Graft Rejection; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D013395:Sucrose
chemical_list: D002241:Carbohydrates; D016756:Immunoglobulins, Intravenous; D013395:Sucrose
keywords: intravenous immunoglobulin; kidney transplantation; osmotic nephrosis; safety; stabilizers; tubular damage