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Observational Study
. 2017 Jun 27;12(6):e0178572.
doi: 10.1371/journal.pone.0178572. eCollection 2017.

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

Marie Matignon  1   2 , Caroline Pilon  2   3 , Morgane Commereuc  4 , Cynthia Grondin  3   5 , Claire Leibler  2   4 , Tomek Kofman  4 , Vincent Audard  2   4 , José Cohen  2   3 , Florence Canoui-Poitrine  6   7 , Philippe Grimbert  1   2
Affiliations
Observational Study

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

Marie Matignon et al. PLoS One. .

Abstract

Background: 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.

Methods: 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-).

Results: 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.

Conclusions: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Evolution of the DSA characteristics and lesion histology from the time of dnDSA detection (biopsy #1) to the time of the second biopsy (biopsy #2).
1.A: Evolution of class I and class II DSA characteristics (number, MFI max and MFI sum). The evolution of all DSA characteristics was similar in the IVIG+ and the IVIG- group. DSA characteristics were also similar in the IVIG+ vs, IVIG- group, at both time points tested. 1.B: Evolution of chronic histologic lesions (ci, ct, cv and ah) as defined in Banff’13 updated classification. No histological differences were found between biopsy #1 and #2, in either the IVIG+ or IVIG- groups. The IVIG+ and control groups were also similar at both time points.
See this image and copyright information in PMC

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