Renal safety of high-dose, sucrose-free intravenous immunoglobulin in kidney transplant recipients: an observational study

Abstract

High-dose intravenous immunoglobulin (IVIg) is commonly used during kidney transplantation. Its nephrotoxicity has been attributed to sucrose stabilizers. We evaluated the renal safety of newer formulations of sucrose-free IVIg. We retrospectively studied clinical and histological data from 75 kidney recipients receiving high-dose, sucrose-free IVIg courses. This group was compared with 75 matched kidney recipients not treated with IVIg. Sucrose-free IVIg treatment was not associated with any acute kidney injury episode at 3 months, but an increased frequency of tubular macrovacuoles (28% vs. 2.8%, P < 0.001) was observed. Among IVIg-treated patients, the presence of macrovacuoles at 3 months was associated with increased IF/TA scores at 3 months (1.7 ± 1 vs. 1 ± 1, P = 0.005) and was more often observed in kidneys with higher IF/TA scores on day 0 (0.6 ± 0.9 vs. 0.3 ± 0.8, P = 0.03) at 3 months. Finally, patients treated with amino-acid-stabilized formulations developed fewer macrovacuoles at 3 months (12% vs. 60%; P < 0.001) than those treated with carbohydrate-stabilized IVIg. Our study shows that high-dose, sucrose-free IVIg use in early kidney recipients is clinically well tolerated. Among sucrose-free IVIg, amino-acid-stabilized formulations are associated with less tubular toxicity than carbohydrate-stabilized IVIg.

Phenotypic and Transcriptomic Lymphocytes Changes in Allograft Recipients After Intravenous Immunoglobulin Therapy in Kidney Transplant Recipients

“…Taken together, our data (clinical and experimental) suggested that the benefits of high dose IVIG after kidney transplantation are limited. Furthermore, high dose IVIG have been associated with more tubular macrovacuoles and chronic tubulointerstitial changes after kidney transplantation (35,36). Our results remain to be confirmed in a larger population which could lead to deep modifications of the current use of high dose IVIG in clinical practice after kidney transplantation.…”

Practical guidance for the diagnosis and management of secondary hypogammaglobulinemia: A Work Group Report of the AAAAI Primary Immunodeficiency and Altered Immune Response Committees

“…Sucrose-free IVIG formulations have been used safely without adverse renal side effects in patients with renal compromise. 315,316 Summary of previously published literature: Nephrotic syndrome Special considerations for nephrotic patients with SHG include the contribution of BCTT and the difficulty of adequate repletion due to urinary protein loss when IgG-RT is deemed necessary. The contribution of SHG in infectious complications of nephrotic syndrome remains unclear.…”

Toxicité rénale des immunoglobulines intraveineuses

“…À partir de 2010, l'utilisation des IgIV sans saccharose a été répandue en vue Celles-ci sont associées à une fibrose interstitielle et à une moins bonne fonction rénale à un an dans une des études [45]. La qualité du greffon (âge du donneur et fibrose interstitielle initiale) semble être un des facteurs favorisant la susceptibilité rénale aux IgIV [45,46]. La seconde étude suggère que les IgIV sans excipient glucidique seraient moins associées à ces lésions tubulaires [46].…”

“…La qualité du greffon (âge du donneur et fibrose interstitielle initiale) semble être un des facteurs favorisant la susceptibilité rénale aux IgIV [45,46]. La seconde étude suggère que les IgIV sans excipient glucidique seraient moins associées à ces lésions tubulaires [46]. Il est à noter que l'on manque de données pour évaluer la toxicité tubulaire des perfusions d'IgIV au long cours et leurs conséquences sur la fibrogenèse et le déclin de la fonction rénale.…”