Intravenous immunoglobulin in kidney transplantation

Fasika M. Tedla, Andrea Roche-Recinos, Amarpali Brar

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations

Abstract

Purpose of review Antibody-mediated injury of renal allografts has assumed increasing importance with the availability of potent immunosuppressants directed against T-lymphocytes. Intravenous immunoglobulin (IVIG) has been used for prevention and treatment of antibody-mediated rejection. The review summarizes recent advances that shed light on mechanisms of action of IVIG and outlines current roles of IVIG in kidney transplantation. Recent findings Observational studies support the use of IVIG for desensitization and treatment of acute rejection. Most studies are small and uncontrolled, but a matched case-control study reported a better survival with incompatible live-donor kidney transplant after desensitization using IVIG-containing regimens compared with dialysis or waiting for compatible transplant. Recent data indicate that variations in glycosylation and amino acid sequence cause the crystallizable fragment of immunoglobulin G to assume specific conformations that have high affinity for canonical crystallizable fragment receptors (FcR) or a newly discovered class of FcRs, labelled type II FcRs. Signaling through type II FcRs appears to trigger antiinflammatory pathways. Summary Recent discoveries expand our understanding of the mechanism of action of IVIG. Future research is expected to clarify the relevance of these findings to humans and could lead to the development of novel immunomodulatory agents.

Original languageEnglish
Pages (from-to)630-637
Number of pages8
JournalCurrent Opinion in Organ Transplantation
Volume20
Issue number6
DOIs
StatePublished - 2015
Externally publishedYes

Keywords

  • Antibody-mediated rejection
  • BK nephropathy
  • Desensitization
  • Intravenous immunoglobulin
  • Kidney transplant

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