Use of high-dose human intravenous immunoglobulin therapy in sensitized patients awaiting transplantation: the Cedars-Sinai experience.

Cedars Sinai Medical Center has developed a protocol using high-dose (2 mg/kg) IVIG to desensitize and transplant patients who are broadly sensitized to HLA antigens. Since 2000, we have evaluated and transplanted 57 broadly sensitized patients (19 with deceased donor and 38 with living donor kidneys) following IVIG treatment. The incidence of allograft rejection was 38.5% and 4-year patient and graft survival rates were 96.5% and 82.5%, respectively. We have also used IVIG in combination with pulse steroids to treat antibody-mediated rejection episodes in 18 patients with C4d deposition in rejection biopsies. Thirteen responded to treatment and 5 grafts were lost in this group with severe antibody-mediated rejection. These results suggest that in many cases high-dose IVIG treatment can neutralize or mitigate antibody responses to eliminate positive donor-specific crossmatches and permit transplantation of broadly sensitized patients and offers a means to treat antibody-mediated rejection successfully.