Division of Nephrology, Mount Sinai School of Medicine, New York, NY, USA.
Clin Transplant. 2012 May-Jun;26(3):E261-8. doi: 10.1111/j.1399-0012.2012.01657.x.
Limited data exist on the effect of intravenous immunoglobulin (IVIg) on anti-HLA antibodies as determined by solid-phase assays. We reviewed our experience treating sensitized wait-listed kidney transplant recipients with IVIg as a method for desensitization and report our results utilizing Luminex single antigen (LSA) bead assay to quantify antibody reactivity (MFI). Fifteen patients with a cPRA > 40% received 2 g/kg IVIg per month for four months or until transplanted. LSA testing was performed before and after IVIg. Median MFI for anti-class I antibodies fell in 11 (73%) and increased in 4 (27%) patients after IVIg. Similar significant changes in MFI for anti-class II antibodies were observed in 10 patients (66%). Administration of IVIg was associated with a modest decrease in reactivity to both class I and II HLA antigens (median MFI change 493 and 1110, respectively; p < 0.0001) but did not significantly alter mean cPRA (85% before IVIg vs. 80% after IVIg; p = 0.1). Our data suggest a smaller effect of IVIg on HLA antibody reactivity than previously described, leading us to question how best to measure the efficacy of a desensitization protocol in current practice.
关于静脉注射免疫球蛋白 (IVIg) 对固相检测法确定的抗 HLA 抗体的影响，目前的数据有限。我们回顾了我们使用 IVIg 对致敏等待肾移植的受者进行脱敏治疗的经验，并利用 Luminex 单抗原 (LSA) 珠检测法报告了我们的结果，以量化抗体反应性 (MFI)。15 名 cPRA > 40%的患者每月接受 2 g/kg IVIg 治疗，持续 4 个月或直至移植。在 IVIg 治疗前后进行 LSA 检测。11 名（73%）患者的抗 I 类抗体 MFI 降低，4 名（27%）患者的 MFI 升高。10 名（66%）患者的抗 II 类抗体 MFI 也观察到类似的显著变化。IVIg 的给药与对 I 类和 II 类 HLA 抗原的反应性适度降低相关（MFI 中位数分别变化 493 和 1110，p < 0.0001），但对平均 cPRA 无显著影响（IVIg 前为 85%，IVIg 后为 80%；p = 0.1）。我们的数据表明 IVIg 对 HLA 抗体反应性的影响比之前描述的要小，这使我们质疑在当前实践中如何最好地衡量脱敏方案的疗效。
