Results of a national survey on the use of IVIg in the treatment of antibody-related rejection after heart transplantation

Abstract

【Objective】 Suppression of rejection is important for maintaining graft function after heart transplantation. Antibody-mediated rejection (AMR), which is a type of rejection, is rare but may seriously damage graft function and lead to heart failure. Therefore, devising a therapeutic strategy for AMR suppression is an extremely important issue. We retrospectively conducted a survey on the actual usage of intravenous immunoglobulin (IVIg) for AMR at transplant facilities in Japan.

【Design and Methods】 In this study, we summarized 11 cases using IVIg for AMR.

【Results】 The average time of diagnosis of AMR was 41.1 months after transplantation, and cardiac dysfunction was observed in 7 patients (64%). As a therapeutic dose of IVIg, half of the doses were as low as 0.2 g/kg. Only 1 case was treated with IVIg alone, and in many cases it was used in combination with plasmapheresis therapy or steroid pulse therapy. As a result of AMR, 9 out of 11 cases (82%) could maintain graft function, while 2 cases lost it. As for changes in anti-HLA antibodies, it was often confirmed that mean fluorescence intensity was suppressed to about half at 6 months after IVIg.

【Conclusion】 It is important to develop standard treatment protocols including IVIg for AMR after heart transplantation.