Sensitization in patients on the waiting-list for a kidney transplantation prolongs time to transplant and in some instances, makes transplantation impossible. Previously published experience from our institution has shown that high antibody levels, especially class I, tend to respond to immunomodulation protocols using IVIG and rituximab (IVIG 2 gm/kg day 1 and 30 – plus rituximab 375 mg/m2 day 15) but that antibody rebound typically occurs 80 – 100 days p-discontinuation of treatment. For this reason, starting in 1/12, we revised our protocol in sensitized patients (class I or II c-PRA > 50 %) to use IVIG as a single agent for a prolonged period (at least 4 months) and in a more frequent dosing pattern in the hope that the prolonged therapy would delay antibody rebound resulting in increased time to achieve a negative crossmatch and/or reduced c-PRA to potential deceased donors thereby extending the window for transplant. A total of 15 patients were entered into this protocol – 8 female and 7 male. While individual MFI's were followed, in order to determine whether the protocol made a difference in "transplantability" of the patients, we report here changes in c-PRA's. All patients were treated with 1 gm/kg of IVIG twice monthly (1st and 3rd week / month). C-PRA's were determined at baseline and prior to the next dose of IVIG with data reporting ending at 4 months. Antibody patterns were followed to look for antibody rebound during therapy as well as the effectiveness of c-PRA reduction. Six patients (5 females / 1 male) showed a diminution in class I cPRA's of at least 5% with only 1 patient showing such an effect in class II antibody levels. Antibody rebound was seen in only 2 of these patients (as determined by c-PRA). Of patients in the protocol, 1 to date has been transplanted. Increasing the duration and frequency of IVIG does not appear to increase the effectiveness of the immunomodulation process as compared to combined IVIG / rituximab but does appear to, in most patients, at least postpone antibody rebound p-treatment. In those patients, then, that respond to the protocol, transplantability of kidney wait-listed patients is enhanced.
To cite this abstract in AMA style:Taber T, Mujtaba M, Goggins W, Higgins N, Sharfuddin A, Yaqub M, Mishler D, Book B, Chen J, Lobashevsky A. Evaluation of an Immunomodulation Program Utilizing IVIG as a Single Agent vs. Combination Therapy with IVIG and Rituximab [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/evaluation-of-an-immunomodulation-program-utilizing-ivig-as-a-single-agent-vs-combination-therapy-with-ivig-and-rituximab/. Accessed March 31, 2020.
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