Clinical Epidemiology and Ageing

Intravenous immunoglobulin therapy in kidney transplant recipients with de novo DSA: Results of an observational study.

Matignon M, Pilon C, Commereuc M, Grondin C, Leibler C, Kofman T, Audard V, Cohen J, Canoui-Poitrine F, Grimbert P PLoS One. 2017;12(6):e0178572.

<p><b>BACKGROUND: </b>Approximately 25% of kidney transplant recipients develop de novo anti-HLA donor-specific antibodies (dnDSA) leading to acute antibody-mediated rejection (ABMR) in 30% of patients. Preemptive therapeutic strategies are not available.</p><p><b>METHODS: </b>We conducted a prospective observational study including 11 kidney transplant recipients. Inclusion criteria were dnDSA 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-dnDSA). The primary efficacy outcome was incidence of clinical and subclinical acute ABMR within 12 months after dnDSA detection as compared to a historical control group (IVIG-).</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>In this first pilot study including kidney allograft recipients with early dnDSA, preemptive treatment with high-dose IVIG alone did not prevent acute ABMR and had minimal effects on DSA outcome and B cell phenotype.</p>

MeSH terms: Adult; Aged; Female; Graft Rejection; Graft Survival; HLA Antigens; Humans; Immunoglobulins, Intravenous; Isoantibodies; Kidney Transplantation; Male; Middle Aged; Pilot Projects; Prospective Studies; Transplant Recipients; Treatment Outcome; Young Adult
DOI: 10.1371/journal.pone.0178572