Purpose. Renal transplant candidates with high levels of anti-HLA antibodies have longer wait times on the deceased donor list and overall lower transplant rates compared to candidates without high levels of anti-HLA antibodies. Desensitization protocols have been utilized by many renal transplant centers to decrease wait times and increase transplant rates for these highly sensitized patients. Intravenous immunoglobulin (IVIG) in combination with plasmapheresis has emerged as a vital component among many desensitization protocols throughout the United States and is the standard protocol used at our institution. We conducted a retrospective chart review of 31 patients to evaluate clinical efficacy and safety, as well as potential cost-savings, comparing high-dose (greater than 2 g/kg total dose) and low-dose IVIG (1 g/kg total dose) desensitization regimens at a single center.

Methods. Patients were evaluated based on the IVIG treatment protocol. A total of 228 patients were reviewed for study inclusion, of which 31 were included in the study (23 in the high dose IVIG group and 8 in the low dose IVIG group). The primary outcome measured was change in serum creatinine at one, three, six and nine months post-transplant. Secondary outcomes measured include graft and patient survival, incidence of acute rejection (cellular and humoral), length of stay, and infectious complications. A descriptive cost analysis over three years was also completed.

Results. Baseline characteristics were similar between both treatment groups. No significant difference was seen in the primary endpoint of change in serum creatinine from discharge to nine months post-discharge. No differences in secondary outcomes were demonstrated. Transplant admission length of stay was decreased with the low-dose IVIG protocol compared to the high- dose IVIG protocols (13 days vs. 7 days; p=0.22). A cost savings of almost $17,000 per case was seen with the low dose IVIG desensitization regimen.

Conclusion. This retrospective study found no difference in change in serum creatinine with implementation of a low-dose IVIG protocol. Decreasing the amount of IVIG for renal transplant desensitization to a total dose regimen of 1 g/kg demonstrated similar efficacy as high-dose protocols while providing significant cost savings.

« Back to 2013 American Transplant Congress