What is the efficacy of high-dose intravenous immunoglobulin (IVIG) to neutralize or mitigate antibody responses following organ transplantation?

Updated: Jul 05, 2018
  • Author: Jessica Katz, MD, PhD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Cedars Sinai Medical Center developed a protocol using high-dose (2 mg/kg) IVIG to desensitize transplantation patients who are broadly sensitized to HLA antigens.

  • Since 2000, 57 broadly sensitized patients (19 with cadaver donor kidneys and 38 with living donor kidneys) have been evaluated and subsequently undergone transplantation following IVIG treatment. The incidence of allograft rejection was 38.5%, and 4-year patient and graft survival rates were 96.5% and 82.5%, respectively.

  • IVIG has also been used in combination with pulse steroids to treat antibody-mediated rejection episodes in 18 patients with C4d deposition in rejection biopsy specimens. Thirteen responded to treatment and 5 grafts were lost in this group with severe antibody-mediated rejections.

  • These results suggest that in many cases, high-dose IVIG treatment can neutralize or mitigate antibody responses to eliminate positive donor-specific crossmatches and permit transplantation of broadly sensitized patients, and they suggest a means to successfully treat antibody-mediated rejection. [50]


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