TY - JOUR
T1 - Chronic intermittent intravenous immunoglobulin in heart transplant recipients with elevated donor-specific antibody levels
AU - Yopes, Margot
AU - Fanek, Tala
AU - Fuselier, Byron
AU - Gaine, Maureen
AU - Jackson, Ruslana
AU - Mabasa, Angelo
AU - Kim, Andrea
AU - Jennings, Douglas L.
AU - Clerkin, Kevin
AU - Yuzefpolskaya, Melana
AU - Habal, Marlena
AU - Latif, Farhana
AU - Restaino, Susan
AU - Lee, Sun Hi
AU - Farr, Maryjane
AU - Colombo, Paolo
AU - Sayer, Gabriel
AU - Uriel, Nir
N1 - Funding Information:
MCY participated in project development, data collection and analysis, and the writing of the article. TF, BF, MG, RJ, AM, AK, and DJ participated in project development and data collection. KC, MH, FL, SR, SHL, MF, and PC participated in manuscript review. GS and NU participated in project development and writing of the article.
Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2022/2
Y1 - 2022/2
N2 - Donor-specific antibodies (DSA) are associated with antibody-mediated rejection (AMR) and poor patient survival. In heart transplant, the efficacy of intermittent intravenous immunoglobulin (IVIg) in reducing de novo DSA levels and treating AMR has not been characterized. We retrospectively studied a cohort of 19 patients receiving intermittent IVIg for elevated DSA and examined changes in DSA levels and graft function. Intermittent IVIg infusions were generally safe and well tolerated. Overall, 23 of 62 total DSA (37%) were undetectable after treatment, 21 DSA (34%) had MFI decrease by more than 25%, and 18 (29%) had MFI decrease by less than 25% or increase. The average change in MFI was -51% ± 71% (P <.001). Despite reductions in DSA, among the six patients (32%) with biopsy-confirmed AMR, left ventricular ejection fraction (LVEF) decreased in five (83%) and cardiac index (CI) decreased in three (50%). Conversely, LVEF increased in 91% and CI increased in 70% of biopsy-negative patients. All six AMR patients were readmitted during treatment, four for confirmed or suspected rejection. IVIg infusions may stabilize the allograft in patients with elevated DSA and negative biopsies, but once AMR has developed does not appear to improve allograft function despite decreasing DSA levels.
AB - Donor-specific antibodies (DSA) are associated with antibody-mediated rejection (AMR) and poor patient survival. In heart transplant, the efficacy of intermittent intravenous immunoglobulin (IVIg) in reducing de novo DSA levels and treating AMR has not been characterized. We retrospectively studied a cohort of 19 patients receiving intermittent IVIg for elevated DSA and examined changes in DSA levels and graft function. Intermittent IVIg infusions were generally safe and well tolerated. Overall, 23 of 62 total DSA (37%) were undetectable after treatment, 21 DSA (34%) had MFI decrease by more than 25%, and 18 (29%) had MFI decrease by less than 25% or increase. The average change in MFI was -51% ± 71% (P <.001). Despite reductions in DSA, among the six patients (32%) with biopsy-confirmed AMR, left ventricular ejection fraction (LVEF) decreased in five (83%) and cardiac index (CI) decreased in three (50%). Conversely, LVEF increased in 91% and CI increased in 70% of biopsy-negative patients. All six AMR patients were readmitted during treatment, four for confirmed or suspected rejection. IVIg infusions may stabilize the allograft in patients with elevated DSA and negative biopsies, but once AMR has developed does not appear to improve allograft function despite decreasing DSA levels.
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U2 - 10.1111/ctr.14524
DO - 10.1111/ctr.14524
M3 - Article
C2 - 34705286
AN - SCOPUS:85118648265
SN - 0902-0063
VL - 36
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 2
M1 - e14524
ER -