# Efficacy of Intravenous Immunoglobulin in Eliminating De Novo Donor-Specific Antibodies After Lung Transplantation: Importance of Early Intervention

## TL;DR

This study shows that early use of intravenous immunoglobulin (IVIG) can help eliminate harmful antibodies in lung transplant patients, potentially improving long-term outcomes.

## Contribution

The study identifies preemptive IVIG therapy as a novel predictor of antibody clearance in lung transplant recipients with de novo donor-specific antibodies.

## Key findings

- 48.9% of patients achieved complete antibody elimination after IVIG-based therapy.
- Preemptive IVIG treatment was an independent predictor of antibody clearance (odds ratio 29.5).
- Responders had lower baseline mean fluorescence intensity (MFI) compared to non-responders.

## Abstract

The development of de novo donor-specific anti-HLA antibodies (dnDSA) after lung transplantation (LuTX) has been increasingly linked to the onset of antibody-mediated rejection (AMR), chronic lung allograft dysfunction (CLAD), and impaired long-term outcomes. However, the therapeutic impact of intravenous immunoglobulin (IVIG) therapy in patients with dnDSA remains unclear. We conducted a retrospective single-center study of LuTX recipients (2015–2019) who developed dnDSA post-transplantation and received IVIG-based therapy. Patients were classified as responders or non-responders based on post-treatment antibody clearance. Clinical, immunological and functional outcomes were compared. Among 47 patients with dnDSA and IVIG-based therapy, 23 (48.9%) achieved complete antibody elimination. Preemptive treatment, defined as initiation of IVIG therapy before onset of clinical symptoms, was found to be an independent predictor of antibody clearance (odds ratio 29.5; p = 0.013). Responders showed significantly lower baseline MFI. While differences in CLAD-free survival favored responders, they did not reach statistical significance. Preemptive IVIG therapy in asymptomatic dnDSA-positive LuTX recipients may enhance antibody clearance and reduce CLAD risk. These findings support early intervention strategies and underscore the need for prospective trials to define optimal therapeutic thresholds and timing.

Title of the study on the efficacy of intravenous immunoglobulin in eliminating donor-specific antibodies after lung transplantation. It covers data from 2014 to 2019 involving 47 patients, showing results of responders and non-responders to the treatment. Visuals include icons of lungs, an antibody, and an IV bag, with key outcomes highlighted. The study is by Maximilian Vorstandlechner and Philip Degenfelder, published in Transpl. Int. 2025. DOI is provided. Logos of ESOT and Transplant International are included.