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Transpl Int. 2016 Nov;29(11):1205-1215. doi: 10.1111/tri.12833. Epub 2016 Sep 9.

Renal safety of high-dose, sucrose-free intravenous immunoglobulin in kidney transplant recipients: an observational study.

Author information

1
Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France. yosu.luque@aphp.fr.
2
Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France;, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Paris, France. yosu.luque@aphp.fr.
3
Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
4
Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
5
Centaure Foundation and Labex Transplantex, Necker Hospital, Paris, France.
6
Anatomie et Cytologie Pathologiques, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
7
Service de Physiologie, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
8
Paris Translational Research Centre for Organ Transplantation, Inserm, UMR-S970, Paris Descartes University, Paris, France.
9
Pharmacie, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.
10
Division of Nephrology and Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montréal, QC, Canada.
11
Service de Néphrologie, Hôpital Foch, Suresnes, France.
12
Urologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.

Abstract

High-dose intravenous immunoglobulin (IVIg) is commonly used during kidney transplantation. Its nephrotoxicity has been attributed to sucrose stabilizers. We evaluated the renal safety of newer formulations of sucrose-free IVIg. We retrospectively studied clinical and histological data from 75 kidney recipients receiving high-dose, sucrose-free IVIg courses. This group was compared with 75 matched kidney recipients not treated with IVIg. Sucrose-free IVIg treatment was not associated with any acute kidney injury episode at 3 months, but an increased frequency of tubular macrovacuoles (28% vs. 2.8%, P < 0.001) was observed. Among IVIg-treated patients, the presence of macrovacuoles at 3 months was associated with increased IF/TA scores at 3 months (1.7 ± 1 vs. 1 ± 1, P = 0.005) and was more often observed in kidneys with higher IF/TA scores on day 0 (0.6 ± 0.9 vs. 0.3 ± 0.8, P = 0.03) at 3 months. Finally, patients treated with amino-acid-stabilized formulations developed fewer macrovacuoles at 3 months (12% vs. 60%; P < 0.001) than those treated with carbohydrate-stabilized IVIg. Our study shows that high-dose, sucrose-free IVIg use in early kidney recipients is clinically well tolerated. Among sucrose-free IVIg, amino-acid-stabilized formulations are associated with less tubular toxicity than carbohydrate-stabilized IVIg.

KEYWORDS:

intravenous immunoglobulin; kidney transplantation; osmotic nephrosis; safety; stabilizers; tubular damage

PMID:
27529401
DOI:
10.1111/tri.12833
[Indexed for MEDLINE]
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