Pretransplant immunomodulation of highly sensitized small bowel transplant candidates with intravenous immune globulin

Gabriel Gondolesi, Benoit Blondeau, Raphael Maurette, Laura Hoppenhauer, Gonzalo Rodriguez-Laiz, Thomas Schiano, Peter Boros, Jonathan Bromberg, Enver Akalin, Bernhard Sauter

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24 Scopus citations

Abstract

Presence of preformed lymphocytotoxic antibodies may represent a barrier to isolated intestinal transplantation (IITx). We developed an intravenous immunoglobulins (IVIg) based desensitization protocol for candidates with high panel-reactive antibodies (PRA). Six patients with a mean PRA of 72±22% were included in a four-level (L) protocol with escalating doses of IVIg (L1, L2), addition of mycophenolate mofetil (MMF) or plasmapheresis (L3); and anti-CD20 (Rituximab) (L4). Four of six candidates improved their PRAs (from a mean of 66.2% to 25.5%; P=0.01) and were successfully transplanted. At a mean follow-up of 8 months, number and severity of rejection episodes of protocol patients did not differ from patients with low PRA transplanted during the same period. These data support the use of IVIg to desensitize patients waiting for IITx. It increases the applicability of IITx, and reduces the waiting time and mortality on the waiting list with outcomes comparable to nonsensitized recipients.

Original languageEnglish (US)
Pages (from-to)1743-1746
Number of pages4
JournalTransplantation
Volume81
Issue number12
DOIs
Publication statusPublished - Jun 1 2006
Externally publishedYes

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Keywords

  • Alloimmunization
  • Immunoglobulins
  • Intestinal transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Gondolesi, G., Blondeau, B., Maurette, R., Hoppenhauer, L., Rodriguez-Laiz, G., Schiano, T., ... Sauter, B. (2006). Pretransplant immunomodulation of highly sensitized small bowel transplant candidates with intravenous immune globulin. Transplantation, 81(12), 1743-1746. https://doi.org/10.1097/01.tp.0000226078.94635.76