Clinical outcomes of polyvalent immunoglobulin use in solid organ transplant recipients: A systematic review and meta‐analysis

Abstract

Polyvalent immunoglobulin is commonly used for desensitization and treatment of antibody‐mediated rejection in kidney transplantation but its impact on other outcomes is not known. This systematic review investigated the impact of immunoglobulin prophylaxis on infection, rejection, graft loss, and death following kidney transplantation. A comprehensive literature search located 18 studies (n = 8 randomized controlled trials). None examined the effect of immunoglobulin prophylaxis in transplant recipients with hypogammaglobulinemia. Quality of included studies was variable with high to very high risk of bias. In the randomized trials, immunoglobulin use did not reduce cytomegalovirus infection (OR 0.68 [0.39, 1.21]; 6 studies, n = 295), rejection (OR 0.96 [0.50, 1.82]; 4 studies, n = 187), or graft loss (OR 1.03 [0.46, 2.30]; 6 studies, n = 265). In non‐randomized studies, immunoglobulin did not reduce cytomegalovirus infection (OR 0.63 [0.20, 1.94]; 6 studies, n = 361) or death (OR 1.32 [0.05, 38.79]; 3 studies, n = 222) but reduce rejection (OR 0.47 [0.24, 0.94]; 4 studies, n = 268) and graft loss (OR 0.15 [0.05, 0.43]; 2 studies, n = 118). Data were scarce and sample size of current evidence was small. Adequately powered randomized trials are needed to determine if immunoglobulin is an effective intervention to reduce infection, rejection, graft loss, or death following kidney transplantation with and without hypogammaglobulinemia.

Secondary antibody deficiency is associated with development of infection in kidney transplantation: Results of a multicenter study

“…Such an approach should include immunoguided long‐term antimicrobial prophylaxis, individualized immunization protocols, or the role of IgG replacement therapy in patients with secondary antibody deficiency. A recent systematic review investigated the impact of immunoglobulin prophylaxis on infection after kidney transplantation 35 . None of the studies examined the effect of this intervention in transplant recipients with secondary antibody deficiency.…”

Pneumocystis Jirovecii Pneumonia in a Kidney Transplant Recipient 13 Months after Transplantation: A Case Report and Literature Review

“…Important to note that while more data supports a positive relation between hypogammaglobulinemia and infections [19,20], some studies concluded otherwise [21]. Nonetheless, there is still no consensus on preventive measures for infections regarding hypogammaglobulinemia in kidney transplant recipients [21,22,23]. In our case of secondary HGG the decision was made to administer IV IgG in order to correct a substantial deficiency and thus possibly improve patient's outcome.…”

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

“…24,39,282 Data are limited and inconclusive regarding the benefit of IVIG for post-KT SHG. 283 IgG-RT has not been found to provide significant survival benefit in intestinal (including liver) transplant. 278,284 IVIG is also used for non-SHG indications, adding nuance to the decision-making around whether or not to treat post-SOT SHG.…”