Factors associated with and predictive of persistence of donor-specific antibody after treatment with plasmapheresis and intravenous immunoglobulin

Antibody to donor HLA antigens is a significant barrier to both access to and outcome of allogeneic transplants. Many attempts have been made to desensitize patients with HLA-specific antibody, but the most effective and durable have been treatment with high-dose pooled human intravenous immunoglobulin (IVIg) and a combination of plasmapheresis and low-dose IVIg. Despite the success of these treatments, low levels of donor-specific antibody (DSA) persist in some patients. We examined factors that may be related to and used to predict the elimination of DSA. The most significant associations have been strength of antibody at initiation of treatment and antibody specificity, although other factors revealed a trend toward association. We demonstrate how the types of data generated here can be used to predict elimination or persistence of DSA.