The Use of IVIG for Solid Organ Transplantation: An Evidence Based Practice Guideline

摘要: Background Utilization of intravenous immune globulin (IVIG) is increasing in Canada and worldwide despite few no new labeled indications. In 2007, Canadian Blood Services collaboration with the National Advisory Committee on Products convened a panel solid organ transplantation (SOT) experts (kidney, heart, lung, liver) methodologists to develop an evidence-based practice guideline for use IVIG patients undergoing SOT. The objectives this are examine evidence who candidates SOT sensitized HLA or ABO antigens, provide guidance practitioners involved care these transfusion medicine specialists IVIG. Methods: identified clinical areas that would benefit from treatment generated key questions. A systematic, expert bibliography literature search up July 2008 was conducted ensure all relevant publications were included. recommendations based evidence. levels grading adapted Task Force Preventative Health Care. To validate conclusions recommendations, will be sent physicians patient representative. Recommendations practitioner feedback incorporated, disseminated receiving aid implementation guideline. subsequently assess performance renew at timely intervals. Results Conclusions: research questions developed by were: Is there reduces morbidity mortality (HLA ABO) perioperative setting experiencing acute graft rejection chronic rejection? 791 citations retrieved, members 3 additional citations. 51 reports systematic review used These limited inconsistent definitions sensitization, reporting type titre antibody, assays detect antibodies, response criteria dosing schedules Thus, consensus process account poor associated decreased sensitization acceptable living donor kidney transplantation. has been several other modalities ABO-incompatible it difficult existing separate outcomes single modality. There also data renal shown effective combination plasmapheresis antibody mediated kidney; however role not clear forms rejection. methodological limitations assessing cardiac only available lung liver Future studies needed define should capture following elements: impact (specificity titres), transplant rates, time transplantation, function, survival, (cellular mediated).