Abstract
【Objective】 The aim of this study was to investigate the efficacy and safety of intravenous immunoglobulin (IVIG)-based therapy for antibody-mediated rejection (AMR) in lung transplantation in Japan.
【Methods】 This retrospective observation study enrolled 48 patients, including 41 adults and 7 children, who underwent IVIG-based therapy for AMR in 4 lung transplant hospitals in Japan between April 2001 and March 2022.
【Results】 AMR was treated by IVIG alone in 18 patients or IVIG combined with other therapies, including, in particular, steroid pulse therapy, plasma exchange, and/or rituximab. The total dose of IVIG was 0.15 g/kg-8.82 g/kg (median: 1.71 g/kg). Donor-specific antibody (DSA) developed in 33 patients after lung transplantation. Following IVIG-based therapy, DSA titer decreased in all DSA to human leukocyte antigen (HLA) class I and 90% of DSA to HLA class II, and AMR was ameliorated in 41 patients (85.4%). The 6- and 12-month graft survival after IVIG-based therapy were 85.4% and 83.0%, respectively. The 6- and 12-month overall survival rates after IVIG-based therapy were 93.8% and 87.5%, respectively. Serious adverse events related directly to IVIG administration were not observed in this study.
【Conclusion】 IVIG-based therapy could be performed safely, could reduce circulating de novo DSA, and could improve AMR after lung transplantation.
