Desensitization Using Only IVIG: Is That an Option for Highly-Sensitized Patients Waiting for Kidneys from Cadaveric Donors?

J. O. Paixão, L. R. Ulisses, P. S. Souza, G. Bezerra, F. Agena, H. P. Rodrgues, N. Panajotopoulos, F. J. Paula, E. David-Neto, M. R. Castro

Nefrologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil

Meeting: 2019 American Transplant Congress

Abstract number: B188

Keywords: Antibodies, Cadaveric organs, Histocompatibility antigens, Immunoglobulins (Ig)

Session Information

Session Name: Poster Session B: Kidney Immunosuppression: Desensitization

Session Type: Poster Session

Date: Sunday, June 2, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: The reduction of anti-HLA has been proven to be efficient and safe in transplants of highly-sensitized with living donors (LD). The results of adopting only IVIG to increase access to deceased donor (DD) transplants in these patients are shown here.

*Methods: Retrospective analysis of highly-sensitized patients enrolled for kidney transplantation with a DD, presenting many positive T or B-cell CDC-XM on the waiting list (WL) and who underwent a desensitization (DS) protocol using IVIg 2g/kg/month, from Jan/03-Dec/13, and followed over 56,18 months (±20,57). Transplants were cleared with the first donor presenting a negative T and B-cell CDC-XM.

*Results: Of the 45 patients evaluated, 6 were excluded (3 obtained a LD and 3 did not complete the minimum of 3 IVIG doses). Of the remaining 39 patients, 14 (35.9%) were transplanted during the follow-up time (FUT), 9 (64.3%) presenting A, B or DR donor specific ab (DSA). For these patients, mean time on the WL before DS was 75±41 months and after DS, 20±11 months (p<0,01). Patients who were given priority on the WL, due to problems on vascular access for dialysis, presented higher transplantation rates: 70% vs 21% (p=0.002). IVIg therapy resulted in a decrease in class I (78.4±26 vs. 69.5±31, p=0.007) and class II PRA (74.36±27.50 vs. 61.79±36.26, p=0.04). There was a significant decrease in the number of anti-HLA antibodies (ab) before and after DS: on MFI levels up to 1500 (11±4 to 3±2, p=0.0002) and between 5000 and 10000 (17±3 to 14±4, p=0.004). Patients transplanted received 7±4 IVIg doses. During the DS process, there was a significant reduction in the immune dominant DSA (iDSA) of those transplanted with a specific ab (3615±1514 vs. 2020±1299, p=0.03). Mean FUT after transplantation was 18.18±16.67 months. After 24 months, patient survival was 92.87% and death-censored graft survival was 96%. ABMR rate was 35.71% and all episodes occurred in patients presenting more than 1 DSA. Renal function (MDRD) in 24 months was not different in patients with and without rejection (36.1 vs. 56.8, p=0.20). No serious side effects related to IV infusions were observed.

*Conclusions: DS using only IVIG has been shown to be effective and safe in reducing the waiting time for DD kidney transplantation in highly-sensitized patients.

To cite this abstract in AMA style:

Paixão JO, Ulisses LR, Souza PS, Bezerra G, Agena F, Rodrgues HP, Panajotopoulos N, Paula FJ, David-Neto E, Castro MR. Desensitization Using Only IVIG: Is That an Option for Highly-Sensitized Patients Waiting for Kidneys from Cadaveric Donors? [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/desensitization-using-only-ivig-is-that-an-option-for-highly-sensitized-patients-waiting-for-kidneys-from-cadaveric-donors/. Accessed November 22, 2024.

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