Impact of intravenous immunoglobulin to penal reactive antibody levels in highly sensitized adult patients waiting for renal transplantation

Simin LIANG; Xiaohou WU; Zhikang YIN; Hang LIU

ABSTRACT

BACKGROUND:

Many methods can reduce panel reactive antibody (PRA) levels in highly sensitized adult patients waiting for renal transplantation. Desensitisation with plasmapheresis or immunoabsorption is commonly used. Howevel the adverse effects limit their applications.

OBJECTIVE:

To investigate the effect of pretreatment of intravenous immunoglobulin (IVIG) on PRA levels in highly sensitized adult patients waiting for renal transplantation. DESIGN, TIME AND

SETTING:

Case analysis, self-contrast of 57 patients waiting for renal transplantation from Ren Transplantation Center. First Affiliated Hospital of Chongqing Medical University between January 2003 and Novembem 2006.

PARTICIPANTS:

Fifty-seven adult patients, who were highly sensitized to the human leucocyte antigen (HLA), agcd 21 to 65 years. were selected. The average baselines of PRA levels of patients were(46.7±29.5)%.

METHODS:

All patients received IVIG pretreatments at a dose of 5 g/d for 2 weeks. as one course of treatment. A weel later. some of them received additional 2 weeks iniection of IVIG. The PRA levels of patients were measured before and just after the IVIG treatments. MAIN OUTCOME

MEASURES:

PRA levels.

RESULTS:

It was significantly decreased below the non-sensitive level(＜10%)in 48 candidates(84.2%),and partially decreased in 6 ones(10.6%),however, was not changed in 3 ones(5.2%).The total effective rate was 94.8%.Thereafter.each candidate received a cadaveric renal graft. The preoperative complement-dependent cytotoxicity of each candidate was blow 10%. Furthermore. no hyperacute rejection was observed in all 57 recipients. Only two recipients experienced acute reiection, however, that was successfully conversed by methylprednisolone and FK506 treatments.

CONCLUSION:

Pretreatment of IVIG is a promising and effective option for lower allosensitization and can improve transplantation in highly sensitized candidates with end-stage renal diseases.