Preemptive immune globulin therapy in sensitized lung transplant recipients

Abstract

Background: Sensitized lung transplant recipients are at increased risk of developing donor-specific antibodies, which have been associated with acute and chronic rejection. Perioperative intravenous immune globulin has been used in sensitized individuals to down-regulate antibody production.

Methods: We compared patients with a pre-transplant calculated panel reactive antibody ≥25% who did not receive preemptive immune globulin therapy to a historical control that received preemptive immune globulin therapy. Our cohort included 59 patients, 17 patients did not receive immune globulin therapy and 42 patients received therapy.

Results: Donor specific antibody development was numerically higher in the non-immune globulin group compared to the immune globulin group (58.8% vs 33.3%, respectively, odds ratio 2.80, 95% confidence interval [0.77, 10.79], p = 0.13). Median time to antibody development was 9 days (Q1, Q3: 7, 19) and 28 days (Q1, Q3: 7, 58) in the non-immune globulin and immune globulin groups, respectively. There was no significant difference between groups in the incidence of primary graft dysfunction at 72 h post-transplant or acute cellular rejection, antibody-mediated rejection, and chronic lung allograft dysfunction at 12 months.

Conclusion: These findings are hypothesis generating and emphasize the need for larger, randomized studies to determine association of immune globulin therapy with clinical outcomes.

Keywords: Donor specific antibody; Immune globulin; Transplant.

Fig. 1.

Flow diagram of study screening and eligibility. ^aDid not survive for reasons unrelated to immunosuppression strategies or rejection.^bIVIG outside of protocol (for example, frequent administration for hypogammaglobulinemia or received intraoperative IVIG but no additional doses)

Figure 2:

Maintenance immunosuppression