LONG-TERM BENEFIT OF INTRAVENOUS IMMUNOGLOBULINS IN CADAVERIC KIDNEY RETRANSPLANTATION

Renal retransplantation can be hampered by the presence of anti-HLA al loantibodies. Previous studies have documented in vitro and in vivo su ppression of these antibodies by intravenous immunoglobulins (IVIg). W e conducted a randomized study in 41 patients, who have received a sec ond cadaveric transplant between 1989 and 1994. They all were treated with a quadruple-immunosuppressive protocol. In addition, 21 patients received 0.4 g/kg/day of IVIg, on the first 5 days after transplantati on. The two groups of patients were identical for age, sex, duration o f the first graft, duration of cold ischemia, anti-HLA sensitization, HLA matching, the number of acute rejection episodes, and the incidenc e of cytomegalovirus infection. The B-year survival rate was significa ntly higher in the group of patients treated with Prig: 68% versus 50% in the control group. The only significant factor associated with Pri g infusion and better survival was a shorter delay of graft function ( 3.4+/-1.0 days versus 9.9+/-1.6 days). In conclusion, this randomized study demonstrates that IVIg treatment is associated with better longt erm graft survival in retransplanted patients. This beneficial effect may be related to a long-lasting immunosuppressive effect of IVIg and/ or to an early protective effect of the graft against ischemia.