Takamatsu Hiroyuki, Yamada Shinya, Tsuji Noriaki, Nakagawa Noriharu, Matsuura Erika, Kasada Atsuo, Sato Keijiro, Hosokawa Kohei, Iwaki Noriko, Arahata Masahisa, Tanaka Hidenori, Nakao Shinji
Department of Hematology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan.
Transplant Direct. 2021 May 18;7(6):e697. doi: 10.1097/TXD.0000000000001146. eCollection 2021 Jun.
IVIG is occasionally used for preventing and treating severe infections of patients who are to undergo transplantation. Administration of IVIG, which includes high-titer antibodies (Abs) against HLA class I and II, might have a substantial influence on the HLA Ab test results of these patients. However, this issue has remained unreported.
Anti-HLA Ab titers were determined in 4 types of IVIG preparations, fresh frozen plasma, and the sera of 11 patients with hematological diseases before and after IVIG administration.
Although anti-HLA Abs were not detected in any of the fresh frozen plasma products, various anti-HLA class I and II Abs were detected in all 4 IVIG preparations. Six out of 11 patients who had received IVIG showed a low titer of anti-HLA class II Abs, which were not detected before IVIG administration. Conversely, no anti-HLA class I Abs were detected in any of the 11 patients. Furthermore, all 4 (100%) patients who were positive for anti-HLA class II Abs initially and were assessable became negative for anti-HLA Abs after the discontinuation of IVIG treatment (median, d 79; range, d 22-192).
IVIG preparations consist of high-titer anti-HLA class I and II Abs, but the latter can be transiently detected in the sera of patients who had received IVIG. When these patients are screened for the presence of donor-specific Abs, some may be incorrectly deemed positive for HLA class II Abs. Thus, caution is necessary when only donor-specific Abs specific to class II HLAs are detected in patients.
静脉注射免疫球蛋白（IVIG）偶尔用于预防和治疗即将接受移植患者的严重感染。IVIG的给药，其中包括针对HLA I类和II类的高滴度抗体（Abs），可能会对这些患者的HLA抗体检测结果产生重大影响。然而，这个问题尚未见报道。
在4种IVIG制剂、新鲜冷冻血浆以及11例血液系统疾病患者静脉注射IVIG前后的血清中测定抗HLA抗体滴度。
虽然在任何新鲜冷冻血浆产品中均未检测到抗HLA抗体，但在所有4种IVIG制剂中均检测到了各种抗HLA I类和II类抗体。11例接受IVIG治疗的患者中有6例出现低滴度抗HLA II类抗体，在静脉注射IVIG前未检测到。相反，11例患者中均未检测到抗HLA I类抗体。此外，最初抗HLA II类抗体阳性且可评估的所有4例（100%）患者在停止IVIG治疗后（中位数，第79天；范围，第22 - 192天）抗HLA抗体变为阴性。
IVIG制剂包含高滴度抗HLA I类和II类抗体，但后者可在接受IVIG治疗的患者血清中短暂检测到。当对这些患者进行供体特异性抗体筛查时，一些患者可能会被错误地判定为HLA II类抗体阳性。因此，当仅在患者中检测到II类HLA特异性的供体特异性抗体时，需要谨慎。
