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Off-Label Use of Intravenous Immunoglobulin for Solid Organ Transplant Rejection: A Review of Clinical Effectiveness

Last updated: April 30, 2018
Project Number: RC0987-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of off-label use of intravenous or subcutaneous immunoglobulin for the treatment of solid organ transplant rejection?

Key Message

One randomized controlled trial and one non-randomized, retrospective, observational study were identified describing the clinical effectiveness of off-label use of intravenous immunoglobulin for the treatment of solid organ transplant rejection. Evidence of moderate quality from one randomized controlled trial investigating intravenous immunoglobulin combined with rituximab versus placebo in 25 renal transplant patients with chronic antibody mediated rejection indicated that there was no important effect on renal function. Evidence of limited quality from one non-randomized, retrospective observational study investigating intravenous immunoglobulin versus methylprednisolone in 39 renal transplant patients with antibody mediated rejection indicated that there was a significant improvement in renal function. Further evidence from larger, long-term studies, including investigating other types of organ transplants, is necessary to reduce uncertainty.