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Effect of high‐dose intravenous immunoglobulin on anti‐ HLA antibodies in sensitized kidney transplant candidates
Author(s) -
Nair Vinay,
Sawinski Deirdre,
Akalin Enver,
Friedlander Rex,
Ebcioglu Zeynep,
Sehgal Vinita,
Dinavahi Rajani,
Khaim Rafael,
Ames Scott,
Lerner Susan,
Murphy Barbara,
Bromberg Jonathan S.,
Heeger Peter S.,
Schröppel Bernd
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2012.01657.x
Subject(s) - medicine , antibody , immunology , human leukocyte antigen , kidney transplant , renal transplant , kidney transplantation , immunoglobulin g , kidney , antigen
Limited data exist on the effect of intravenous immunoglobulin ( IVI g) on anti‐ HLA antibodies as determined by solid‐phase assays. We reviewed our experience treating sensitized wait‐listed kidney transplant recipients with IVI g 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 c PRA > 40% received 2 g/kg IVI g per month for four months or until transplanted. LSA testing was performed before and after IVI g. Median MFI for anti‐class I antibodies fell in 11 (73%) and increased in 4 (27%) patients after IVI g. Similar significant changes in MFI for anti‐class II antibodies were observed in 10 patients (66%). Administration of IVI g 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 c PRA (85% before IVI g vs. 80% after IVI g; p = 0.1). Our data suggest a smaller effect of IVI g on HLA antibody reactivity than previously described, leading us to question how best to measure the efficacy of a desensitization protocol in current practice.