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Ivig and rejection

Megan A Rocchio, James W Schurr, Aaron P Hussey, Paul M Szumita
BACKGROUND: In October 2010, a pharmacist-driven stewardship program was implemented at the Brigham and Women's Hospital to ensure continued adherence to the prescribing guideline, focusing on indications for intravenous immune globulin (IVIG) use and dosing per ideal body weight. OBJECTIVE: The primary objective was to describe an IVIG stewardship program at a tertiary academic medical center. METHODS: This was a prospective, observational study from January 2013 through December 2014...
October 6, 2016: Annals of Pharmacotherapy
Chih-Yuan Lee, Wei-Chou Lin, Ming-Shiou Wu, Ching-Yao Yang, Chi-Chuan Yeh, Meng-Kun Tsai
BACKGROUND/PURPOSE: Intravenous immunoglobulin (IVIG) plays a central role in the treatment of antibody-mediated rejection (AMR) of renal allografts, but the treatment outcomes for late AMR (>6 months after transplantation) are poor. METHODS: We performed a retrospective study to assess the response patterns of IVIG-based (2 g/kg) desensitization for late AMR. Patients who received desensitization after the pathological diagnosis of late AMR positive for complement component C4d were grouped as the Desensitized Group and compared to a historical Control Group with complement component C4d positivity in retrospective stainings...
October 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Joseph Kahwaji, Stanley C Jordan, Reiad Najjar, Patarapha Wongsaroj, Jua Choi, Alice Peng, Rafael Villicana, Ashley Vo
BACKGROUND: Desensitization with intravenous immunoglobulin (IVIG) and rituximab can improve transplantation rates in broadly sensitized kidney transplant recipients. However, long-term outcomes are lacking. Here we analyze long-term outcomes in living donor kidney transplant recipients desensitized with this regimen and compare them to low-risk recipients. METHODS: Living donor kidney transplants that took place between July 2006 and December 2010 were considered retrospectively...
August 16, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
David Shaffer, Irene D Feurer, Deborah Crowe, Heidi Schaefer
BACKGROUND: Desensitization with IVIG and rituximab allows acceptable graft survival in sensitized kidney transplant recipients with preexisting donor-specific antibodies (DSAs) and a positive crossmatch. There is little published data reporting the durability of DSA removal in kidney transplant recipients treated with IVIG and rituximab. METHODS: We conducted a 3-year prospective DSA monitoring study in living donor kidney recipients with preexisting DSA to assess the durability of DSA removal after a perioperative protocol of IVIG and rituximab...
February 2016: Transplantation Direct
A Furmańczyk-Zawiska, A Urbanowicz, A Perkowska-Ptasińska, T Bączkowska, A Sadowska, S Nazarewski, A Chmura, M Durlik
BACKGROUND: Antibody-mediated rejection (ABMR) has emerged as the leading cause of renal graft loss. The optimal treatment protocol in ABMR remains unknown. This study aimed to assess the efficacy of intravenous immunoglobulin (IVIG) for treatment of ABMR in renal recipients. METHODS: Thirty-nine ABO-compatible cross-match-negative renal recipients with biopsy-proven ABMR composed the study group. Pulses of methylprednisolone (MP) and appropriate enhancement of net state of immunosuppression were applied in all individuals; 17/39 recipients were administered IVIG (IVIG group); the remaining 22/39 patients, identified to be nonadherent or unsatisfactorily immunosuppressed, were kept on the initial treatment (MP group)...
June 2016: Transplantation Proceedings
Irene K Kim, Jua Choi, Ashley A Vo, Alexis Kang, Mitasha Patel, Mieko Toyoda, James Mirocha, Elaine S Kamil, J Louis Cohen, Sabrina Louie, Odette Galera, Stanley C Jordan, Dechu P Puliyanda
BACKGROUND: Studies show that alemtuzumab, a potent lymphocyte-depleting agent, is well tolerated in pediatric renal transplantation. We report on the use of alemtuzumab induction in highly HLA sensitized (HS) pediatric kidney transplant patients. METHODS: 50 pediatric renal transplants were performed from 1/2009-12/2014. 15 HS patients received IVIG (2gm/kg x2 doses) /rituximab (375mg/m x1) for desensitization with alemtuzumab induction (15-30mg, 1 dose, subcutaneous), while 35 nonsensitized patients received anti-IL-2R...
August 5, 2016: Transplantation
Masaki Honda, Seisuke Sakamoto, Rieko Sakamoto, Shirou Matsumoto, Tomoaki Irie, Koushi Uchida, Keita Shimata, Seiichi Kawabata, Kaori Isono, Shintaro Hayashida, Hidekazu Yamamoto, Fumio Endo, Yukihiro Inomata
We herein present the case of a four-yr-old boy with PA who developed AMR after ABO-incompatible LDLT despite undergoing B cell desensitization using rituximab. Although the CD19+ lymphocyte count decreased to 0.1% nine days after the administration of rituximab, he developed a high fever which was accompanied by arthralgia due to a streptococcal infection 13 days after rituximab prophylaxis. After the clearance of the infection, he underwent ABO-incompatible LDLT 36 days after the administration of rituximab...
September 2016: Pediatric Transplantation
Philip T Thrush, Elfriede Pahl, David C Naftel, Elizabeth Pruitt, Melanie D Everitt, Heather Missler, Steven Zangwill, Michael Burch, Timothy M Hoffman, Ryan Butts, William T Mahle
BACKGROUND: Current knowledge of antibody-mediated rejection (AMR) after heart transplantation (HT) stems largely from adult data. Using the Pediatric Heart Transplant Study (PHTS) database, we report the incidence of AMR, describe treatment, and evaluate outcomes for treated AMR in children after HT. METHODS: We queried the PHTS database for patients <18 years of age undergoing primary HT between January 2010 and December 2014. An AMR episode was defined as either a biopsy consistent with pathologic AMR or a rejection event based on immunotherapy augmentation directed against antibody production...
June 24, 2016: Journal of Heart and Lung Transplantation
Lindsay H Laws, Clare E Parker, Ganesh Cherala, Yoshinobu Koguchi, Ari Waisman, Mark K Slifka, Martin H Oberbarnscheidt, Jagdeep S Obhrai, Melissa Y Yeung, Leonardo V Riella
B cells play a central role in antibody-mediated rejection and certain auto-immune diseases. However, B-cell-targeted therapy such as anti-CD20 B cell-depleting antibody(aCD20) has yielded mixed results in improving outcomes. In this study, we investigated whether an accelerated B-cell reconstitution leading to aCD20 depletion-resistance could account for these discrepancies. Using a transplantation model, we found that antigen-independent inflammation, likely through TLR signals, was sufficient to mitigate B cell depletion...
June 6, 2016: American Journal of Transplantation
S C Jordan, J Choi, J Kahwaji, A Vo
The presence of HLA antibodies remains a significant and often impenetrable barrier to kidney transplantation, leading to increased morbidity and mortality for patients remaining on long-term dialysis. In recent years, a number of new approaches have been developed to overcome these barriers. Intravenous immunoglobulin (IVIG) remains the lynchpin of HLA desensitization therapy and has been shown in a prospective, randomized, placebo-controlled trial to improve transplantation rates. In addition, IVIG used in low doses with plasma exchange is a reliable protocol for desensitization...
April 2016: Transplantation Proceedings
B J Orandi, B E Lonze, A Jackson, S Terezakis, E S Kraus, N Alachkar, S M Bagnasco, D L Segev, J B Orens, R A Montgomery
Patients requiring desensitization prior to renal transplantation are at risk for developing severe antibody-mediated rejection (AMR) refractory to treatment with plasmapheresis and intravenous immunoglobulin (PP/IVIg). We have previously reported success at graft salvage, long-term graft survival and protection against transplant glomerulopathy with the use of eculizumab and splenectomy in addition to PP/IVIg. Splenectomy may be an important component of this combination therapy and is itself associated with a marked reduction in donor-specific antibody (DSA) production...
May 23, 2016: American Journal of Transplantation
Amit Sharma, Anne King, Dhiren Kumar, Martha Behnke, Felecia McDougan, Pamela M Kimball
CONTEXT: Graft failure due to chronic rejection is greater among renal transplant patients with donor-specific antibody (DSA) than among DSA-free patients. For patients dependent on deceased donor transplantation, preoperative desensitization to eliminate DSAs may be impractical. We speculated that perioperative desensitization might eliminate preexisting DSAs and prevent de novo DSAs and improve graft outcomes. We report that brief perioperative desensitization using either intravenous immunoglobulin (IVIG) or plasmapheresis/IVIG (PP/IVIG) treatment improves clinical outcomes among patients with positive crossmatches...
June 2016: Progress in Transplantation
R A Montgomery, B J Orandi, L Racusen, A M Jackson, J M Garonzik-Wang, T Shah, E S Woodle, C Sommerer, D Fitts, K Rockich, P Zhang, M E Uknis
Antibody-mediated rejection (AMR) is typically treated with plasmapheresis (PP) and intravenous immunoglobulin (standard of care; SOC); however, there is an unmet need for more effective therapy. We report a phase 2b, multicenter double-blind randomized placebo-controlled pilot study to evaluate the use of human plasma-derived C1 esterase inhibitor (C1 INH) as add-on therapy to SOC for AMR. Eighteen patients received 20 000 units of C1 INH or placebo (C1 INH n = 9, placebo n = 9) in divided doses every other day for 2 weeks...
May 16, 2016: American Journal of Transplantation
R Parekh, M Kazimi, S Skorupski, O Fagoaga, S Jafri, M C Segovia
BACKGROUND: We describe our experience using a modified protocol for immunosuppression for intestine transplantation across a positive crossmatch. Patients who underwent transplantation in 2013 were evaluated over a 12-month period for rejection and infectious events with comparison to procedure-matched controls on our standard protocol of immunosuppression. PATIENTS AND METHODS: We used a modified protocol for intestine and multivisceral transplantation for patients with a positive flow crossmatch...
March 2016: Transplantation Proceedings
Lionel Rostaing, Béatrice Karam, Nicolas Congy-Jolivet, Valérie Hage, Federico Sallusto, Laure Esposito, Nicolas Doumerc, Bénédicte Debiol, Céline Guilbeau-Frugier, Xavier Game, Asma Allal, Nassim Kamar
Few studies have assessed the outcomes of ABOi/HLAi living-kidney transplantation. We report a single-center experience of 12 ABOi/HLAi living-kidney recipients. Twenty-seven donor-specific alloantibodies (DSAs) (1-6 per patient) were found with fluorescence intensities of 1500-15 000. Desensitization was based on IVIg, two doses of rituximab (375 mg/m(2) ), tacrolimus-based (0.2 mg/kg) immunosuppression (started on day-10 pretransplant), and 11 (6-27) pretransplant apheresis sessions (plasmapheresis, specific or semi-specific immunoadsorption)...
April 13, 2016: Therapeutic Apheresis and Dialysis
P K Jha, S B Bansal, S K Sethi, M Jain, R Sharma, A Nandwani, M K Phanish, R Duggal, A K Tiwari, P Ghosh, R Ahlawat, V Kher
ABO incompatibility has been considered as an important immunological barrier for renal transplantation. With the advent of effective preconditioning protocols, it is now possible to do renal transplants across ABO barrier. We hereby present a single center retrospective analysis of all consecutive ABOi renal transplants performed from November 2011 to August 2014. Preconditioning protocol consisted of rituximab, plasmapheresis and intravenous immunoglobulin (IVIG) and maintenance immunosuppression consisted of tacrolimus, mycophenolate sodium, and prednisolone...
March 2016: Indian Journal of Nephrology
Vural Taner Yilmaz, Gultekin Suleymanlar, Sadi Koksoy, Burak Veli Ulger, Sebahat Ozdem, Halide Akbas, Bahar Akkaya, Huseyin Kocak
INTRODUCTION: The aim of our study was to determine the effectiveness of immunoglobulin, rituximab and plasmapheresis in renal transplant patients with antibody mediated rejection (AMR). PATIENTS AND METHODS: Fourteen renal transplant patients with AMR were included in this study. The mean age of the patients was 33.9 ± 10.3 years and 10 (71.4%) of them were male. Lymphocyte cross match was negative for all patients and 10 (71.4%) of them were living donor transplants...
October 2016: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
E M Staley, S S Carruba, M Manning, H P Pham, L A Williams, M B Marques, J E Locke, R G Lorenz
Patients receiving ABO-incompatible (ABOi) kidney transplants are treated before and after transplant with combination therapy, such as intravenous immunoglobulin (IVIG) and therapeutic plasma exchange, to prevent allograft rejection by reducing anti-A and anti-B titers. Although generally considered safe, it is well known that commercial IVIG products contain detectable anti-A and anti-B, which can be associated with hemolysis. Different preparative manufacturing techniques during the production of IVIG affect ABO antibody levels in IVIG preparations; therefore, some manufacturers now use new methods to reduce anti-A/B levels at the preproduction stage...
August 2016: American Journal of Transplantation
Jong Cheol Jeong, Enkthuya Jambaldorj, Hyuk Yong Kwon, Myung-Gyu Kim, Hye Jin Im, Hee Jung Jeon, Ji Won In, Miyeun Han, Tai Yeon Koo, Junho Chung, Eun Young Song, Curie Ahn, Jaeseok Yang
Combination therapy of intravenous immunoglobulin (IVIG) and rituximab showed a good transplant rate in highly sensitized wait-listed patients for deceased donor kidney transplantation (DDKT), but carried the risk of antibody-mediated rejection. The authors investigated the impact of a new combination therapy of bortezomib, IVIG, and rituximab on transplantation rate.This study was a prospective, open-labeled clinical trial. The desensitization regimen consisted of 2 doses of IVIG (2  g/kg), a single dose of rituximab (375  mg/m), and 4 doses of bortezomib (1...
February 2016: Medicine (Baltimore)
R A Montgomery
No abstract text is available yet for this article.
May 2016: American Journal of Transplantation
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