Background: Donor-specific HLA antibody (DSA) formation in post-renal transplant patients is associated with chronic rejection and graft failure. Previous studies in our population have indicated that DSA formation is a strong predictor of graft loss (>20% at 3 years). Detection of DSA may occur months or years after transplantation and often occurs months before graft dysfunction, affording providers time to intervene. This study proposed to utilize high dose intravenous immunoglobulin (IVIG) to reduce DSAs and therefore prevent future graft dysfunction.

Methods: Thirty-eight DSA positive renal transplant patients were given intermittent high dose IVIG (2 grams/kg) for at least one month and a maximum of six months. DSA levels and renal function were monitored during the course of treatment. HLA single antigen beads were analyzed by Luminex to determine donor specificity and strength of the antibodies, measured as mean fluorescence intensity (MFI). Participants' immunosuppression consisted of thymoglobulin induction, Prednisone, Tacrolimus, and MPA.

Results: Transplant to development of DSA averaged 44 months. Following IVIG treatment, 92% of patients with Class I DSA experienced a mean reduction of 72% and 82% with Class II DSA experienced a mean reduction of 53%. Graft function remained stable in most patients with DSA reduction.

Conclusion: IVIG appears to lower DSA intensity; however, it may not always correlate with better graft function. The temporal relationship of DSA and IVIG may be the most critical step in achieving success. This intervention for DSA reduction needs further investigation to evaluate the long term benefits of IVIG.

« Back to 2015 American Transplant Congress