Korean J Nephrol.  2009 Jul;28(4):375-380.

Intravenous Immunoglobulin Treatment in a Kidney Transplant Patient with Chronic Antibody-Mediated Rejection

• Byun SW
• Yeo Y
• Park JS
• Cho YM
• Park SK

Abstract

A 66-year-old male was admitted for increasing azotemia. He was diagnosed with chronic antibody- mediated rejection and had received a livingdonor renal transplant from his 32-year-old son prior to his admission. The peritubular capillaries of his kidney were diffusely positive on C4d immunostaining. It is known that there is an agreement between C4d staining and serological and histopathological data during rejection that is thought to have a humoral component. The role of alloantibodies in chronic renal allograft deterioration and the corresponding morphologic changes have been increasingly recognized during the recent years. However the treatment guidelines for chronic antibody-mediated rejection have not yet been established. Intravenous immunoglobulin (IVIG) has been shown to decrease the titers of anti-HLA antibodies in highly sensitized patients awaiting transplant. There are also numerous proposed mechanisms regarding how IVIG exerts its immunomodulatory action. As we have experienced chronic antibody-mediated rejection and how IVIG treatment improves renal function, we recognize that IVIG has the potential to be used for treating certain subgroups of chronic allograft nephropathy patients with positive C4d staining and anti-HLA antibodies.

Keyword

Complement component 4d; Rejection; Intravenous immunoglobulins; Human leukocyte antigens

MeSH Terms

Adult
Aged
Antibodies
Azotemia
Capillaries
Complement C4b
HLA Antigens
Humans
Immunoglobulins
Immunoglobulins, Intravenous
Isoantibodies
Kidney
Male
Peptide Fragments
Rejection (Psychology)
Transplantation, Homologous
Transplants
Antibodies
Complement C4b
HLA Antigens
Immunoglobulins
Immunoglobulins, Intravenous
Isoantibodies
Peptide Fragments