Intravenous Immunoglobulin: A Safe Option for Treatment of Steroid-Resistant Rejection in the Presence of Infection

Moger, Venkatesh; Ravishankar, Machiraju S.; Sakhuja, Vinay; Kohli, Harbir Singh; Sud, Kamal; Gupta, Krishan Lal; Jha, Vivekanand

doi:10.1097/01.tp.0000122415.08639.53

Cited by 12 publications

(8 citation statements)

References 8 publications

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“…IVIG has a number of potential properties to prevent rejection including reduction of alloantibodies through anti‐idiotypic circuits, inhibition of inflammatory cytokine generation and inhibition of complement‐mediated injury 8 . IVIG needs to be administered with care as high doses of certain preparations (high sucrose/osmolarity) can cause acute tubular necrosis and acute renal failure 9 . Limited supply remains a major issue, and an alternative strategy suggested to prevent rejection in the case of infection or malignancy incorporates reduction of maintenance immunosuppressives and the temporary use of IL‐2 blockade 10 …”

Section: Discussionmentioning

confidence: 99%

“…8 Moger et al have also reported the use of IVIG as a safe agent for the treatment of steroid-resistant rejection in the presence of concomitant infection. 9 IVIG has a number of potential properties to prevent rejection including reduction of alloantibodies through anti-idiotypic circuits, inhibition of inflammatory cytokine generation and inhibition of complement-mediated injury. 8 IVIG needs to be administered with care as high doses of certain preparations (high sucrose/osmolarity) can cause acute tubular necrosis and acute renal failure.…”

Section: Discussionmentioning

confidence: 99%

“…8 IVIG needs to be administered with care as high doses of certain preparations (high sucrose/osmolarity) can cause acute tubular necrosis and acute renal failure. 9 Limited supply remains a major issue, and an alternative strategy suggested to prevent rejection in the case of infection or malignancy incorporates reduction of maintenance immunosuppressives and the temporary use of IL-2 blockade. 10 This case demonstrates the immunosuppressed status of dialysis patients prior to transplantation.…”

Section: Discussionmentioning

confidence: 99%

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Miliary tuberculosis in a Caucasian male transplant recipient and the role of intravenous immunoglobulin as an immunosuppressive sparing agent (Case Report)

Lian¹,

Chan²,

Slavin

et al. 2006

Nephrology

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Opportunistic infections are a common and anticipated accompaniment of transplantation, but are generally somewhat predictable in their timing and epidemiology. The authors report here a case of miliary tuberculosis occurring within 3 weeks of transplantation, in a patient not expected to be significantly at risk, and with a normal chest X-ray at the time of transplantation. A 25-year-old Caucasian male dialysis patient who received two paediatric kidneys as an en bloc renal transplant developed fever 3 weeks following transplantation; this eventually proved to be miliary tuberculosis. As well as antituberculous therapy and a significant reduction in the patient's conventional immunosuppression, intravenous immunoglobulin was used as anti-rejection prophylaxis. The case highlights the immunosuppressed status of dialysis patients prior to transplantation and the need for broad differential diagnosis in transplant recipients even in the absence of recognized epidemiological factors. The case also emphasizes the role of intravenous immunoglobulin as an anti-rejection therapy that does not add to the patient's immunosuppressive burden.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Miliary tuberculosis in a Caucasian male transplant recipient and the role of intravenous immunoglobulin as an immunosuppressive sparing agent (Case Report)

Lian¹,

Chan²,

Slavin

et al. 2006

Nephrology

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“…They found complete elimination of HLA antibody in six of seven patients with class I antibody and one of three patients with class II antibody. IVIG has also been used, successfully, to treat antibody-mediated rejection (50)(51)(52) and to increase the opportunity for heart transplantation (36,53).…”

Section: High Dose Ivigmentioning

confidence: 99%

Desensitization for solid organ and hematopoietic stem cell transplantation

Zachary

Leffell

2014

Immunological Reviews

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Desensitization protocols are being used worldwide to enable kidney transplantation across immunologic barriers, i.e. antibody to donor HLA or ABO antigens, which were once thought to be absolute contraindications to transplantation. Desensitization protocols are also being applied to permit transplantation of HLA mismatched hematopoietic stem cells to patients with antibody to donor HLA, to enhance the opportunity for transplantation of non-renal organs, and to treat antibody-mediated rejection. Although desensitization for organ transplantation carries an increased risk of antibody-mediated rejection, ultimately these transplants extend and enhance the quality of life for solid organ recipients, and desensitization that permits transplantation of hematopoietic stem cells is life saving for patients with limited donor options. Complex patient factors and variability in treatment protocols have made it difficult to identify, precisely, the mechanisms underlying the downregulation of donor-specific antibodies. The mechanisms underlying desensitization may differ among the various protocols in use, although there are likely to be some common features. However, it is likely that desensitization achieves a sort of immune detente by first reducing the immunologic barrier and then by creating an environment in which an autoregulatory process restricts the immune response to the allograft.

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“…The immunomodulatory effects of IVIg rapidly led to a broader usage of IVIg in autoimmune and inflammatory disorders, usually at much higher doses (1). More recently, IVIg has been used in kidney transplantation for decreasing panel reactive antibodies in highly sensitized patients (2) and for the treatment of antibody-mediated rejection (AMR) (3)(4)(5). Although many consider that all IVIg products are similar, it now is clear that they differ greatly in regard to excipient compounds and related adverse effects (6).…”

mentioning

confidence: 99%

Safety and Adverse Events Profiles of Intravenous Gammaglobulin Products Used for Immunomodulation

Cam

Toyoda

et al. 2006

Clinical Journal of the American Society of Nephrology

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Intravenous Ig (IVIg) products are used in various medical conditions. Differences in excipients account for most adverse events (AE). Reports of complications including acute myocardial infarction (AMI) and acute renal failure (ARF) have emerged. Herein is described one institution's experience with IVIg-related complications. This study is a retrospective analysis of infusion-related AE that are associated with various IVIg products. Infusion-related AE were monitored during and after the administration of three IVIg products: Gamimune-N 10% (n ‫؍‬ 76), Polygam (n ‫؍‬ 105), and Carimune (n ‫؍‬ 98). AE segregated to specific IVIg products. No patients who received Gamimune-N experienced AMI or ARF. Five (4.7%) patients (P < 0.01) in the Polygam group experienced AMI. Eight (8.2%) patients (P < 0.0001) in the Carimune group developed ARF. IVIg was safe to give on hemodialysis. IVIg products differ in osmolality, pH, and sugar and sodium content; this results in specific AE. Polygam resulted in no ARF but an increase in AMI. Carimune products at 9% concentration resulted in an increase in ARF. Gamimune-N 10% and other IVIg products were frequently associated with headaches. Administration of IVIg to patients who are on hemodialysis seems to be safe and effective.

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Intravenous Immunoglobulin: A Safe Option for Treatment of Steroid-Resistant Rejection in the Presence of Infection

Cited by 12 publications

References 8 publications

Miliary tuberculosis in a Caucasian male transplant recipient and the role of intravenous immunoglobulin as an immunosuppressive sparing agent (Case Report)

Miliary tuberculosis in a Caucasian male transplant recipient and the role of intravenous immunoglobulin as an immunosuppressive sparing agent (Case Report)

Desensitization for solid organ and hematopoietic stem cell transplantation

Safety and Adverse Events Profiles of Intravenous Gammaglobulin Products Used for Immunomodulation

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