Intravenous immunoglobulin induction treatment in flow cytometry cross-match-positive kidney transplant recipients

Many recent studies have demonstrated increased acute humoral, cellular, subclinical, or chronic rejection, and decreased allograft survival in flow cytometry cross-match-positive kidney transplant recipients. The use of newer techniques and more sensitive of enzyme-linked immunosorbent assay (ELISA) or Flow Beads (microparticle based methods), donor-specific anti-human leukocyte antigen (HLA) antibodies have been detected in these immunologically high-risk patients. Intravenous immunoglobulin (IVIG) has immunomodulatory effects and has been demonstrated to downregulate anti-HLA antibodies in highly sensitized dialysis patients awaiting transplantation. Our initial studies demonstrate that IVIG induction treatment is promising in flow cytometry cross-match-positive kidney transplant recipients, and thus, those patients should not be excluded from receiving transplantation despite a positive flow cytometry cross match. Further studies with long-term follow-up are required to determine the effective dose and duration of IVIG treatment, and additional studies are needed to determine the most accurate tests for risk stratification. (c) American Society for Histocompatibility and Immunogenetics, 2005. Published by Elsevier Inc.