Abstract: SA-PO1153
Absence of Histologic Improvement Despite Reduction of Donor-Specific Antibodies with IVIG Treatment of Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Tsai, Stephanie, Weill Cornell Medicine, Richmond, Texas, United States
- Gupta, Mohit, Weill Cornell Medicine, Richmond, Texas, United States
- Edusei, Emmanuel Y., Weill Cornell Medicine, Richmond, Texas, United States
- Sharma, Vijay K., Weill Cornell Medicine, Richmond, Texas, United States
- Lee, Jun B., Weill Cornell Medicine, Richmond, Texas, United States
- Lee, John Richard, Weill Cornell Medicine, Richmond, Texas, United States
- Muthukumar, Thangamani, Weill Cornell Medicine, Richmond, Texas, United States
- Everly, Matthew, Terasaki Research Institute, Los Angeles, California, United States
- Dadhania, Darshana, Weill Cornell Medicine, Richmond, Texas, United States
Background
Donor-specific antibodies to donor HLA (DSA) are associated with higher incidence of antibody-mediated rejection and graft loss. Intravenous immunoglobulin (IVIG) exerts immunomodulatory effects in both humoral and cellular pathways. We examined the impact of IVIG therapy on circulating DSA, graft histology, and graft function.
Methods
18 kidney transplant recipients with DSA maximum fluorescence intensity (MFI) ≥1000 treated with IVIG 1g/kg every 2 weeks x 6 months and a control cohort of 13 recipients with DSA managed as per physician preference were analyzed. In the IVIG-treated cohort, responders were defined by ≥50% reduction in DSA MFI-Sum at 18 months after start of IVIG. Baseline characteristics and graft function were compared between IVIG and control cohort.
Results
While there was no significant difference in baseline eGFR between groups, there was a significant decrease in eGFR in the control group at 18 months (Figure 1), and 23% of the control group had graft loss, compared to 0% in the treatment group. Ten recipients in the IVIG cohort met the definition of “responder.” There were no significant differences in graft function between responders and non-responders at start of IVIG or at 18 months post-treatment (Table 1). There was no change in pre- and post-IVIG histologic Banff scores in both responders and non-responders (Figure 2a and 2b).
Conclusion
IVIG therapy is associated with DSA reduction and stabilization of renal allograft function in some patients. However, despite significant reduction in DSA, there was no change in histologic parameters after IVIG therapy. Prospective randomized controlled trials with longer-term follow-up are needed to evaluate the beneficial impact of IVIG.