Open AccessIntravenous immunoglobulin therapy in kidney transplant recipients with de novo DSA: Results of an observational study
Author(s) -
Marie Matig,
C. Pilon,
Morgane Commereuc,
Cynthia Grondin,
Claire Leibler,
Tomek Kofman,
Vincent Audard,
José L. Cohen,
Florence CanouïPoitrine,
Philippe Grimbert
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0178572
Subject(s) - medicine , subclinical infection , observational study , antibody , gastroenterology , biopsy , kidney , kidney transplantation , incidence (geometry) , prospective cohort study , immunology , physics , optics
Background Approximately 25% of kidney transplant recipients develop de novo anti-HLA donor-specific antibodies ( dn DSA) leading to acute antibody-mediated rejection (ABMR) in 30% of patients. Preemptive therapeutic strategies are not available. Methods We conducted a prospective observational study including 11 kidney transplant recipients. Inclusion criteria were dn DSA occurring within the first year after transplant and normal allograft biopsy. All patients were treated with high-dose IVIG (2 g/kg 0, 1 and 2 months post- dn DSA). The primary efficacy outcome was incidence of clinical and subclinical acute ABMR within 12 months after dn DSA detection as compared to a historical control group (IVIG-). Results Acute ABMR occurred in 2 or 11 patients in the IVIG+ group and in 1 of 9 patients in the IVIG- group. IVIG treatment did not affect either class I or class II DSA, as observed at the end of the follow-up. IVIG treatment significantly decreased FcγRIIA mRNA expression in circulating leukocytes, but did not affect the expression of any other markers of B cell activation. Conclusions In this first pilot study including kidney allograft recipients with early dn DSA, preemptive treatment with high-dose IVIG alone did not prevent acute ABMR and had minimal effects on DSA outcome and B cell phenotype.