PLoS ONE (Jan 2017)

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

  • Marie Matignon,
  • Caroline Pilon,
  • Morgane Commereuc,
  • Cynthia Grondin,
  • Claire Leibler,
  • Tomek Kofman,
  • Vincent Audard,
  • José Cohen,
  • Florence Canoui-Poitrine,
  • Philippe Grimbert

DOI
https://doi.org/10.1371/journal.pone.0178572
Journal volume & issue
Vol. 12, no. 6
p. e0178572

Abstract

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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.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-).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.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.