2010 - TTS International Congress


This page contains exclusive content for the member of the following sections: TTS. Log in to view.

Complications Cardiovascular

31.7 - Slow and Steady, Reducing Thrombotic Events in Renal Transplant Recipients Treated with IVIg for Antibody-Mediated Rejection

Presenter: William, Mulley, Clayton, Australia
Authors: Huang L., Kanellis J., Mulley W.

SLOW AND STEADY, REDUCING THROMBOTIC EVENTS IN RENAL TRANSPLANT RECIPIENTS TREATED WITH IVIG FOR ANTIBODY-MEDIATED REJECTION

COMPLICATIONS - CARDIOVASCULAR

L. Huang1, J. Kanellis2, W. Mulley2
1Nephrology, Monash Medical Centre, Clayton/AUSTRALIA, 2Department Of Medicine, Monash University, Clayton/AUSTRALIA

Body: Introduction: Intravenous immunoglobulin (IVIg) therapy for antibody mediated rejection (AMR) is increasing but is associated with a significant incidence of arterial and venous thromboses. We aimed to determine whether a specific infusion protocol for IVIg would lead to reduced thrombosis rates in patients treated for AMR. Methods: Patients treated with IVIg (1gm/kg) for AMR from 8/2007-8/2009 were variably given enoxaparin (20-40mg) pre-infusion. IVIg was infused at up to 200mg/kg/hr. In August 2009 an IVIg infusion protocol was implemented, comprising: aspirin 300mg, enoxaparin 1mg/kg and intravenous hydration with isotonic saline pre and post-infusion. The maximum IVIg infusion rate was reduced to 100mg/kg/hr. Events were included if they occurred within 7 days of the infusion and were verified by history, examination, biochemistry and Doppler ultrasonography as indicated. Thrombosis rates were determined retrospectively pre-protocol and prospectively post-protocol. Results: 274 infusions were administered pre-protocol, with a thrombosis rate of 3.3% (8 events in 7 patients). Patient characteristics are shown in the table below. Whilst clotted arterio-venous fistulae (AVF) were most commonly encountered, more significant events also occurred. One patient developed bilateral above knee deep venous thromboses (DVT) whilst 2 patients experienced arterial thrombotic events. An acute myocardial infarct (AMI) was diagnosed immediately post infusion in patient 8 whilst patient 7 developed a renal artery thrombosis which lead to infarction of 2/3 of his graft. None of the patients were known to have a pre-existing clotting diathesis. The event rate was similar whether or not enoxaparin was given (3.5% and 3.2% respectively). Since introduction of the IVIg infusion protocol 66 infusions have been administered with no thrombotic events. There have been no significant bleeding or fluid overload side-effects encountered thus far. Infusion times however have doubled resulting in increased staffing requirements and inconvenience for patients. Conclusions: The risk of thrombosis following IVIg infusion is small; however the potential consequences are considerable. A slower rate of infusion combined with anti-platelet and anticoagulation therapy appears to reduce thrombosis rates without resulting in significant side-effects. With IVIg usage increasing for the treatment of AMR and other indications in renal transplant recipients, further study is required to define the ideal infusion protocol wherein a balance needs to be struck between safety and efficiency.

Disclosure: All authors have declared no conflicts of interest.


Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada