Abstracts

THE EFFICACY OF INTRAVENOUS IMMUNE GLOBULIN (IVIG) IN SMALL BOWEL AND MULTIVISCERAL ALLOGRAFTS TRANSPLANTED ACROSS A POSITIVE LYMPHOCYTOTOXIC CROSSMATCH

Karen Laughlin, Lillian Martin, June Stamos, Darlene Koritsky, Igor Dvorchik, Tong Wu, Noriko Murase, Guilherme Costa, Geoffrey Bond, Kareem Abu-Elmagd. University of Pittsburgh Medical Center, Thomas E Starzl Transplantation Institute, Pittsburgh, PA.

Purpose:  IVIG has immunomodulatory effects that include inhibition of HLA alloantibody synthesis. This study addresses the prophylactic efficacy of IVIG among highly sensitized intestinal/multivisceral transplant recipients.

Methods:  Between August 1990 and December 2005, 47 adult allografts were transplanted across positive T and/or B cell lymphocytotoxic crossmatch. The liver was part of the visceral graft in 22(47%) recipients and the remaining 25(53%) received intestinal allograft with inclusion of the pancreas in 6. The remaining patient received an intestine and kidney from the same donor. All grafts were ABO identical and HLA match was random. Attempts were made to simultaneously replace the native liver of the intestine-kidney recipient for immunoprotection since she lost 2 previous kidney allografts because of rejection. Since November 2002, a single perioperative intravenous dose of IVIG(2g/kg) was given to 19 of the overall 47 positive crossmatch allograft recipients. Type of allograft, HLA mismatch, donor/recipient CMV status, and cold ischemia time were similar between the two groups. Induction therapy/pretreatment was utilized in 90% of IVIG recipients and 38% of controls with IL-2 antagonist or rATG/alemtuzumab. All reported rejection episodes were histologically documented and medically treated. The study period included the first 90 days after transplantation.

Results:  IVIG recipients experienced less(p=0.27) intestinal allograft cellular rejection(47%) compared to control group(64%). However, frequency and severity of rejection were similar between the two cohorts(p>0.05). There was a single example of intestinal vascular rejection in each group and the kidney-intestinal recipient experienced severe humoral rejection of both organs successfully treated with IVIG, plasmapheresis, cytoxan and OKT3. None of the allografts were lost during the study period due to humoral, cellular or chronic rejection.

Conclusion:  The use of IVIG in presensitized small bowel/multivisceral recipients reduces risk of rejection within the first 90 days after transplantation. However, further longitudinal follow-up is required to assess the cumulative impact of IVIG and pretreatment on long-term survival of the intestinal and other simultaneously transplanted organ allografts.

Top Updated 9/19/06