Treatment of donor-specific antibody-mediated rejection after heart transplantation by IgM-enriched human immunoglobulin

被引：3
|
作者：
Immohr, Moritz Benjamin [1 ]
Akhyari, Payam [1 ]
Aubin, Hug [1 ]
Westenfeld, Ralf [2 ]
Mehdiani, Arash [1 ]
Bruno, Raphael Romano [2 ]
Sipahi, Nihat Firat [1 ]
Erbel-Khurtsidze, Sophiko [1 ]
Reinecke, Petra [3 ]
Tudorache, Igor [1 ]
Lichtenberg, Artur [1 ]
Boeken, Udo [1 ]
机构：
[1] Heinrich Heine Univ, Med Sch, Med Fac, Dept Cardiac Surg, Moorenstr 5, D-40225 Dusseldorf, Germany
[2] Heinrich Heine Univ, Med Sch, Dept Cardiol Pulmonol & Vasc Med, Dusseldorf, Germany
[3] Heinrich Heine Univ, Med Sch, Inst Pathol, Dusseldorf, Germany
来源：
ESC HEART FAILURE | 2021年 / 8卷 / 04期
关键词：
Heart transplantation; Antibody mediated rejection; Immunoglobulin; IgM; Donor specific antibody;
D O I：
10.1002/ehf2.13409
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Antibody-mediated graft rejection caused by donor-specific antibodies (DSA-MR) remains a serious problem after heart transplantation (HTx). IgM-enriched human intravenous immunoglobulin (IGM-IVIG) consists of 76% IgG, 12% IgM, and 12% IgA and provides a new multifactorial approach for DSA-MR. Between 2017 and 2020, four (P1-4) of 102 patients developed DSA-MR after HTx in our department and were repetitively treated with IGM-IVIG in combination with anti-thymocyte globulin. While in P1 and P4, DSA-MR occurred within the early post-operative interval, P2 and P3 developed DSA-MR approximately 1 year after transplantation. An impairment of ventricular function was observed in three of four patients. Furthermore, P1 and P4 suffered from malign ventricular arrhythmias. After the application of IGM-IVIG, the ventricular function recovered, and all patients could be discharged from the hospital. As part of a multifactorial therapeutic approach, treatment with IGM-IVIG seems to be a safe and effective strategy to address DSA-MR.
引用
收藏
页码：3413 / 3417
页数：5
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