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SOLID ORGAN TRANSPLANT CANDIDATES DEMONSTRATE VARIOUS SENSITIVITY TO IVIG.
Andrew Lobashevsky 1,2, Nancy Higgins 2, Kevin Rosner 2, Tim Taber MD 2, Bryan Haag MD 2, Mark Pescovitz MD 1, Mohammed Govani MD 1, William Goggins MD 1, Jackie O'Donnell MD 1, Mark Turrentine MD 2, Robert Darragh MD 2 and Randall Caldwell MD 2. 1 Medicine, Transplant Immunology Laboratory, Indiana University, Indianapolis, IN, USA and 2 Transplant Immunology Laboratory, Methodist Hospital, Indianapolis, IN, USA .
Transplant candidates (TC) with a high level of preformed alloantibodies are disadvantaged for transplantation. One of the strategies that have been proposed to find a suitable donor for them involves reducing of alloantibodies in serum of highly sensitized recipients (HSR) by plasmopheresis (PP) and administration of IVIG. The purpose of this study was to analyze serial serum samples from HSR pre- and post-IVIG treatment. Sera from four renal and three heart TC were analyzed. PRA, antibody specificity and cross matching (XM) were done by CDC-AHG and flow cytometry (FC). For deceased donors 2.0 g/kg of IVIG/month (x4) and for living donors 100mg/kg of IVIG plus PP/month (x2-6) were used. Sera for analysis were taken pre- and post-IVIG infusion. PRA levels ranged from 45% to 90%. Five TC were CDC and FC XM positive with their potential donors, and two were FC XM positive only. In four cases positive results of FC XM were caused by donor specific class I and class II antibodies. Conversion of positive to negative CDC XM and MCS under IVIG treatment was observed in four and five TC respectively. No effect on PRA, CDC XM and FC XM was observed in one heart recipient. Five recipients were transplanted. Antibody mediated graft failure was observed three months later in one kidney recipient. Our results indicate that preliminary XM and antibody specificity analysis after cycles of IVIG treatment present reliable prognostic criteria for graft outcome in early post-transplant period in HSR.