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Posttransplant Prophylactic Intravenous Immunoglobulin in Kidney Transplant Patients at High Immunological Risk: A Pilot Study
Author(s) -
Anglicheau D.,
Loupy A.,
Suberbielle C.,
Zuber J.,
Patey N.,
Noël L.H.,
Cavalcanti R.,
Le Quintrec M.,
Audat F.,
Méjean A.,
Martinez F.,
MamzerBruneel M.F.,
Thervet E.,
Legendre C.
Publication year - 2007
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2007.01752.x
Subject(s) - medicine , immunosuppression , gastroenterology , antibody , nephropathy , kidney , kidney transplantation , urology , transplantation , surgery , immunology , endocrinology , diabetes mellitus
The effects of posttransplant prophylactic intravenous immunoglobulin (IVIg) were investigated in renal transplant recipients at high immunological risk. Thirty‐eight deceased‐donor kidney transplant recipients with previous positive complement‐dependent cytotoxicity crossmatch (n = 30), and/or donor‐specific anti‐HLA antibodies (n = 14) were recruited. IVIg (2 g/kg) was administrated on days 0, 21, 42 and 63 with quadruple immunosuppression. Biopsy‐proven acute cellular and humoral rejection rates at month 12 were 18% and 10%, respectively. Glomerulitis was observed in 31% and 60% of patients at months 3 and 12, respectively, while allograft glomerulopathy rose from 3% at month 3 to 28% at 12 months. Interstitial fibrosis/tubular atrophy increased from 18% at day 0 to 51% and 72% at months 3 and 12 (p < 0.0001). GFR was 50 ± 17 mL/min/1.73 m 2 and 48 ± 17 mL/min/1.73 m 2 at 3 and 12 months. PRA decreased significantly after IVIg (class I: from 18 ± 27% to 5 ± 12%, p < 0.01; class II: from 25 ± 30% to 7 ± 16%, p < 0.001). Patient and graft survival were 97% and 95%, respectively and no graft was lost due to rejection (mean follow‐up 25 months). In conclusion, prophylactic IVIg in high‐immunological risk patients is associated with good one‐year outcomes, with adequate GFR and a profound decrease in PRA level, but a significant increase in allograft nephropathy.