Solid organ transplant, active antibody-mediated rejection (ABMR) prevention and management
Recommended Indications in which IG can be used
Order Number: T3-ABMR
| Recommendations | Pre-transplant: IVIG is recommended when an antibody or antibodies might preclude transplantation (e.g., donor specific anti-human leukocyte antigen antibody or anti-blood group antibody). IG may be continued for up to 3 months post-transplant. Post-transplant: IG may be used to treat active ABMR when other therapies are ineffective. |
| Dose/Frequency of Administration | IVIG with plasma exchange: 0.1 g/kg adjusted body weight after each plasma exchange, to a maximum total dose of 2 g/kg. IVIG alone: 2 g/kg adjusted body weight divided over 2 to 5 days. When IVIG is used alone, further doses may be indicated every 4 weeks for a further three cycles, depending on clinical response or biopsy findings. Thereafter, additional treatment cycles (often together with other treatment modalities) may be indicated, but only when biopsy findings and/or clinical response demonstrate ongoing/recurrent active ABMR or chronic active ABMR. Demonstration of ongoing/recurrent active ABMR or chronic active ABMR should precede each treatment cycle. Note: Some sucrose-stabilized formulations of IVIG have shown nephrotoxicity and are best avoided in patients with pre-existing kidney impairment. Some nephrologists recommend that IVIG infusions be capped at 140 g/day to reduce the risk of nephrotoxicity. |