Infusion of High-Dose Intravenous Immunoglobulin Fails to Lower the Strength of Human Leukocyte Antigen Antibodies in Highly Sensitized Patients
Infusion of High-Dose Intravenous Immunoglobulin Fails to Lower the Strength of Human Leukocyte Antigen Antibodies in Highly Sensitized Patients
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DOI：
10.1097/tp.0b013e318253f7b6
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发表时间：
2012-07-27
期刊：
影响因子：
6.2
通讯作者：
Singer, Andrew L.
中科院分区：
文献类型：
--
作者：
Alachkar, Nada;Lonze, Bonnie E.;Singer, Andrew L.
背景。人白细胞抗原（HLA）致敏是等待肾移植患者的主要障碍。高剂量静脉注射免疫球蛋白（IVIg）治疗后，HLA抗体降低，移植率良好。我们招募了27例中位流式细胞术计算的面板反应性抗体（CPRA）为100%，平均等待时间超过4年的患者，采用高剂量IVIg治疗，对治疗前后获得的血清HLA抗体谱进行了特征分析，并对所有血型相同的肾脏供体进行了交叉匹配试验。在同样敏感的历史对照组中，12.8%的患者在一年内接受了移植，而在研究期间，接受ivig治疗的患者中有41%接受了移植。令人惊讶的是，通过CPRA测量的HLA抗体谱显示对IVIg治疗的反应没有显着变化。事实上，使用死去的同种异体移植供者的预处理血清进行回顾性交叉匹配试验表明，在输注IVIg之前，所有患者都符合各自供者的移植条件。这项研究并没有证实先前的报道，即在使用大剂量IVIg脱敏的广泛致敏患者中，CPRA减少导致死亡供体移植率增加。与历史对照相比，移植率的增加与交叉配型合格性的提高无关，可能是由于使用细胞毒性强度阈值进行频繁交叉配型、移植医疗准备程度的提高以及新认识到的活体供体移植选择，所有这些都可以在没有IVIg治疗的情况下实现。
Background. Human leukocyte antigen (HLA) sensitization presents a major obstacle for patients awaiting renal transplantation. HLA antibody reduction and favorable transplantation rates have been reported after treatment with high-dose intravenous immunoglobulin (IVIg).Methods. We enrolled 27 patients whose median flow cytometric calculated panel reactive antibody (CPRA) was 100% and mean wait-list time exceeded 4 years in a protocol whereby high-dose IVIg was administered, HLA antibody profiles of sera obtained before and after treatment were characterized, and cross-match tests were performed with all blood group identical kidney offers.Results. Whereas 12.8% of a similarly sensitized historic control cohort underwent transplantation in the course of a year, 41% of the IVIg-treated group underwent transplantation during the study period. Surprisingly, HLA antibody profiles, measured by CPRA, showed no significant change in response to IVIg treatment. In fact, retrospective cross-match testing using pretreatment sera of those receiving deceased-donor allografts showed that all patients would have been eligible for transplantation with their respective donors before IVIg infusions.Conclusions. This study does not corroborate previous reports of CPRA reduction leading to increased deceased-donor transplantation rates in broadly sensitized patients undergoing desensitization with high-dose IVIg. The increased rate of transplantation relative to historic controls is not related to improved cross-match eligibility and likely resulted from frequent crossmatching using a cytotoxic strength threshold, improved medical readiness for transplantation, and newly recognized options for live-donor transplantation, all of which could have been achieved without IVIg treatment.