Immunomodulatory actions of intravenous immunoglobulin (IVIG): potential applications in solid organ transplant recipients.

Intravenous gammaglobulin (IVIG) products are known to have powerful immunomodulatory and anti-inflammatory functions in vitro and in vivo. In addition, IVIG has shown benefit in the treatment of many human autoimmune and inflammatory disorders. One potential mechanism of action responsible for these beneficial effects is the down-regulation of deleterious autoantibody titers through idiotypic-anti-idiotypic networks. Until recently, few data were available on the use of IVIG in the management of alloimmune disorders. In this review, we will discuss current data on the use of pooled human gammaglobulin as an agent with potential to regulate undesirable alloimmune responses and allosensitization through similar idiotypic-anti-idiotypic circuits and how this therapy could be of benefit in the management of highly sensitized patients both pre- and post-transplant. We will also discuss other potential anti-inflammatory and immunoregulatory mechanisms induced by IVIG treatment and how these may be applied to improve transplantability and outcomes in human transplantation.