Anglicheau D, Loupy A, Suberbielle C, Zuber J, Patey N, Noël L-H, Cavalcanti R, Le Quintrec M, Audat F, Méjean A, Martinez F, Mamzer-Bruneel M-F, Thervet E, Legendre C
Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP, Paris, F-75015 France.
Am J Transplant. 2007 May;7(5):1185-92. doi: 10.1111/j.1600-6143.2007.01752.x. Epub 2007 Mar 12.
The effects of posttransplant prophylactic intravenous immunoglobulin (IVIg) were investigated in renal transplant recipients at high immunological risk. Thirty-eight deceased-donor kidney transplant recipients with previous positive complement-dependent cytotoxicity crossmatch (n=30), and/or donor-specific anti-HLA antibodies (n=14) were recruited. IVIg (2 g/kg) was administrated on days 0, 21, 42 and 63 with quadruple immunosuppression. Biopsy-proven acute cellular and humoral rejection rates at month 12 were 18% and 10%, respectively. Glomerulitis was observed in 31% and 60% of patients at months 3 and 12, respectively, while allograft glomerulopathy rose from 3% at month 3 to 28% at 12 months. Interstitial fibrosis/tubular atrophy increased from 18% at day 0 to 51% and 72% at months 3 and 12 (p<0.0001). GFR was 50 +/- 17 mL/min/1.73 m(2) and 48 +/- 17 mL/min/1.73 m(2) at 3 and 12 months. PRA decreased significantly after IVIg (class I: from 18 +/- 27% to 5 +/- 12%, p<0.01; class II: from 25 +/- 30% to 7 +/- 16%, p<0.001). Patient and graft survival were 97% and 95%, respectively and no graft was lost due to rejection (mean follow-up 25 months). In conclusion, prophylactic IVIg in high-immunological risk patients is associated with good one-year outcomes, with adequate GFR and a profound decrease in PRA level, but a significant increase in allograft nephropathy.
对具有高免疫风险的肾移植受者进行了移植后预防性静脉注射免疫球蛋白（IVIg）效果的研究。招募了38例既往补体依赖细胞毒性交叉配型呈阳性（n = 30）和/或存在供体特异性抗HLA抗体（n = 14）的脑死亡供体肾移植受者。IVIg（2 g/kg）在第0、21、42和63天给药，并联合四联免疫抑制治疗。12个月时经活检证实的急性细胞性和体液性排斥反应发生率分别为18%和10%。在第3个月和第12个月时，分别有31%和60%的患者观察到肾小球炎，而异体移植肾小球病从第3个月时的3%升至12个月时的28%。间质纤维化/肾小管萎缩从第0天的18%增加至第3个月时的51%和第12个月时的72%（p<0.0001）。第3个月和第12个月时的肾小球滤过率分别为50±17 mL/min/1.73 m²和48±17 mL/min/1.73 m²。IVIg治疗后群体反应性抗体（PRA）显著下降（I类：从18±27%降至5±12%，p<0.01；II类：从25±30%降至7±16%，p<0.001）。患者和移植物存活率分别为97%和95%，且无移植物因排斥反应丢失（平均随访25个月）。总之，对高免疫风险患者进行预防性IVIg治疗与良好的一年期预后相关，肾小球滤过率充足且PRA水平显著降低，但异体移植肾病显著增加。
