Plasmapheresis with intravenous immunoglobulin G is effective in patients with elevated panel reactive antibody prior to cardiac transplantation

Pisani, Barbara; Mullen, G. M.; Malinowska, Krystyna; Lawless, Christine E.; Méndez, José; Silver, Marc A.; Radvany, Ruta; Robinson, John A.

doi:10.1016/s1053-2498(99)00022-4

Cited by 131 publications

(90 citation statements)

References 5 publications

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“…Fiveyear graft survival was significantly higher in the IVIgtreated group (68%, versus 50% in the control group). A similar study in heart transplantation demonstrated that the survival of 16 immunised patients treated with IVIgs and plasmapheresis was identical to the survival of nonimmunised patients [56].…”

Section: Ivlgs and Transplantationmentioning

confidence: 79%

Intravenous immunoglobulins and transplantation for patients with anti-HLA antibodies

Glotz

Antoine

Julia

et al. 2004

Transplant International

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Transplantation for patients possessing allo-antibodies against HLA antigens can be delayed for years, and, once the graft has been transplanted, its survival is significantly reduced. We and others have shown that administration of intravenous immunoglobulins (IVIgs) can induce a profound and sustained decrease in the titres of the anti-HLA antibodies, thus greatly enhancing the chances of those patients to obtain a transplant. In a number of cases, pre-treatment sera contained anti-donor antibodies that disappeared after IVIg administration. A similar approach, combining plasmapheresis and low-dose IVIgs, has shown similar results and has been successfully applied to ABOincompatible transplantations. Patient and graft survival are excellent, despite a rather high rate of rejections, most notably humoral ones. These protocols thus demonstrate that the presence of anti-donor antibody, once an absolute contraindication to transplantation, can, nowadays, be considered as an immunological hurdle that can be managed through appropriate immunological manipulation.

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Section: Ivlgs and Transplantationmentioning

confidence: 79%

Intravenous immunoglobulins and transplantation for patients with anti-HLA antibodies

Glotz

Antoine

Julia

et al. 2004

Transplant International

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“…Sensitized patients undergoing pretransplant plasmapheresis and IVIG treatments present with a frequency of graft rejection and survival similar to patients negative for anti-HLA antibodies. 65,66 Intravenous immunoglobulin was found to be an important component in desensitization protocols and in AMR treatment, especially in kidney transplant. 67 Despite the fact that using high-dose IVIG was beneficial in treating idiopathic and virally induced cardiomyopathy, the advantage for its use in desensitization and in AMR therapy in heart failure is less evident.…”

Section: Classic Approaches On Sensitized Patientsmentioning

confidence: 99%

“…68 Because evidence in favor or against routine use of IVIG as a desensitizing agent and in improving transplant outcome is insufficient, further randomized and standardized clinical trials are required to verify the effectiveness of this approach. [66][67][68] Several studies have underscored that the desensitization effect, with IVIG and plasmapheresis, also depends on the polymorphism of genes encoding INF-γ, IL-2, and IL-4Rα proteins. 69 These findings suggest that cytokine polymorphisms and anti-HLA antibody analyses would be important to identify potential resistance to desensitization treatment and determine the appropriate therapeutic approach.…”

Section: Classic Approaches On Sensitized Patientsmentioning

confidence: 99%

Current Concepts in Histocompatibility During Heart Transplant

Picascia

Grimaldi²,

Zullo³

et al. 2012

Exp Clin Transplant

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Sensitized candidates for heart transplant usually end up on a long waiting list and have an increased risk of rejection, graft loss, and incidence of cardiac allograft vasculopathy. An increasing number of studies have demonstrated the negative effect of preformed and posttransplant antibodies on graft survival. Thus, in sensitized patients, the combination of new, appropriate, desensitization protocols, and monitoring of posttransplant development of donor-specific antibodies may improve short-term and long-term outcomes. Introduction of more-sensitive and more-specific techniques for antibody detection provides a valid tool for assessing the degree of pretransplant HLA histocompatibility, and, therefore, predicting the results of crossmatch in sensitized patients, which are difficult to transplant. Currently, there are no accurate and standard methods to determine the functional characteristics of antibodies detected by solid-phase assay and, therefore, to predict their clinical relevance. Therefore, the future of heart transplantation requires a better understanding of tissue typing techniques and the effect of anti-HLA antibodies on clinical outcome to prevent discrimination against sensitized patients at the time of organ allocation.

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“…In the setting of antibody-mediated rejection, IVIG has been shown to be beneficial when used in conjunction with plasmapheresis and/or rituximab (Lefaucher et al, 2009;Shehata et al, 2010). As a desensitization agent alone, no study has demonstrated a clear benefit (Pisani et al, 1999;Shehata et al, 2010). Definitive reduction of antibody was not shown and a survival advantage was not evident.…”

Section: Applicationsmentioning

confidence: 99%