EFFECT OF INTRAVENOUS IMMUNOGLOBULIN AND SIMVASTATIN ON SUPPRESSION OF HLA ALLOANTIBODIES IN SENSITIZED TRANSPLANT CANDIDATES

Abstract

A120 Aims: The goal of this study was to assess the efficacy and the utility of Immunoglobulin (IVIG) and simvastatin as potential modalities for the treatment of sensitized transplant candidates. Materials: The study included 11 patients with end stage renal disease who were waiting for living related renal allotransplantation. All patients included in the study were older than 18 years, maintained on hemodialysis, had persistently positive crossmatches with their living related donors and panel reactive antibody (PRA) titer ≥20%. HIV or hepatitis B surface antigen positive patients, patients with previous history of blood transfusion, IVIG or immunosuppressant administration in the last 6 months, and also females who were lactating or pregnant were excluded from the study. All patients received IVIG in a dose of 500 mg/Kg/day, every other day, for a period of two weeks at a total of 6 doses. PRA titer and crossmatch testing were carried out after each dose and before each subsequent one. Two months later, non-responders received simvastatin in a dose of 20 mg/day, orally for a period of two months. PRA titer and crossmatch testing were carried out every two weeks. Results: Four out of the 11 patients (36%) showed improvement in their PRA activity where the mean PRA titers before and after IVIG administration were 39±18% and 37±17% respectively, however this improvement did not rank to a statistical significance (p=0.36). Moreover, simvastatin resulted also in a non significant improvement of PRA in 5 out of the 11 patients (45%), mean PRA titers before and after simvastatin administration were 37±17% and 40±20% respectively (p=0.32). Repeated crossmatch testing showed that none of the patients could attain a negative crossmatch reaction. Conclusions: IVIG or simvastatin alone can not effectively inhibit preformed anti-HLA antibodies to allow successful renal transplantation. Further trials of the use of IVIG or simvastatin with other more powerful modalities of treatment to desensitize these patients may be warranted.