Preemptive treatment of early donor-specific antibodies with IgA- and IgM-enriched intravenous human immunoglobulins in lung transplantation.

Autor: Ius F; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Verboom M; Department of Transfusion, Medicine Hannover Medical School, Hannover, Germany., Sommer W; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany.; German Center for Lung Research (DZL/BREATH), Hannover, Germany., Poyanmehr R; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Knoefel AK; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Salman J; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Kuehn C; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Avsar M; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Siemeni T; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Erdfelder C; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Hallensleben M; Department of Transfusion, Medicine Hannover Medical School, Hannover, Germany., Boethig D; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Schwerk N; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.; Department of Paediatrics, Hannover Medical School, Hannover, Germany., Mueller C; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.; Department of Paediatrics, Hannover Medical School, Hannover, Germany., Welte T; German Center for Lung Research (DZL/BREATH), Hannover, Germany.; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany., Falk C; Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany., Haverich A; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany.; German Center for Lung Research (DZL/BREATH), Hannover, Germany., Tudorache I; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Warnecke G; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany.; German Center for Lung Research (DZL/BREATH), Hannover, Germany.
Jazyk: angličtina
Zdroj: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2018 Sep; Vol. 18 (9), pp. 2295-2304. Date of Electronic Publication: 2018 Jun 03.
DOI: 10.1111/ajt.14912
Abstrakt: This retrospective study presents our 4-year experience of preemptive treatment of early anti-HLA donor specific antibodies with IgA- and IgM-enriched immunoglobulins. We compared outcomes between patients with antibodies and treatment (case patients) and patients without antibodies (control patients). Records of patients transplanted at our institution between March 2013 and November 2017 were reviewed. The treatment protocol included one single 2 g/kg immunoglobulin infusion followed by successive 0.5 g/kg infusions for a maximum of 6 months, usually combined with a single dose of anti-CD20 antibody and, in case of clinical rejection or positive crossmatch, with plasmapheresis or immunoabsorption. Among the 598 transplanted patients, 128 (21%) patients formed the case group and 452 (76%) the control group. In 116 (91%) patients who completed treatment, 106 (91%) showed no antibodies at treatment end. Fourteen (13%) patients showed antibody recurrence thereafter. In case versus control patients and at 4-year follow-up, respectively, graft survival (%) was 79 versus 81 (P = .59), freedom (%) from biopsy-confirmed rejection 57 versus 53 (P = .34), and from chronic lung allograft dysfunction 82 versus 78 (P = .83). After lung transplantation, patients with early donor-specific antibodies and treated with IgA- and IgM-enriched immunoglobulins had 4-year graft survival similar to patients without antibodies and showed high antibody clearance.
(© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.)
Databáze: MEDLINE
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