IMMUNOGLOBULIN THERAPY IN TRANSPLANTATION OF ORGANS AND TISSUES. REVIEW

Abstract

Relevance. The expediency of prescribing immunotherapy for the transplantation of solid organs is still the subject of discussions among transplantologists.
 Objective. An analysis of key clinical trials devoted to the study of various aspects of the efficacy and safety of intravenous immunoglobulin therapy in allogeneic solid organ recipients with consideration of possible indications for the use of immunotherapy in transplant practice according to the current evidence base.
 Materials and methods. Retrospective analysis of the literature in depth in 20 years (1996-2016) in science-based databases PubMed, Scholar. Different approaches, different immunomodulating strategies (monotherapy, combination), different fields of application (transplantology, immunodeficiency states) were considered.
 Results. Currently accumulated evidence is determined the efficacy and safety i/v immunoglobulin therapy in monotherapy or in combination with other immunomodulatory strategies such as plasmapheresis and rituximab for the prevention and treatment of rejection reactions of allogenic kidney, where present donor-specific antibodies. It also shows that i/v immunotherapy compensates secondary humoral immunodeficiency in recipients of allogeneic heart, thereby sharply reducing the risk associated with immunosuppression severe infections and increases the survival of patients. Of interest are studies on the efficacy of specific immunoglobulins in a transplantology.
 Conclusions. Although in the case of transplanttion of solid organs, there is less evidence base of immunotherapy efficacy than in recipients of allogeneic bone marrow, through the now accumulated evidence that normal i/v human immunoglobulin can be used advantageously for the treatment and prevention of various infectious and immune-dependent complications in certain subgroups of patients with internal organs transplants or in nonstandard clinical cases as part of personalized medicine.