A NEW randomised controlled trial has shown that intravenous immunoglobulin (IVIG) may stabilise kidney function and reduce tissue damage in transplant recipients facing chronic active antibody-mediated rejection (AMR)—a leading cause of kidney transplant failure.
Published as part of the VIPAR trial, this multicentre study enrolled 30 kidney transplant recipients with biopsy-confirmed chronic active AMR. Participants were randomised to receive either six monthly doses of IVIG or standard care without IVIG. Researchers tracked kidney tissue damage using the chronic allograft damage index (CADI) over a 12-month period, alongside kidney function and immune response markers.
The results were promising. Patients in the IVIG group showed no progression in CADI scores, while those in the control group experienced a steady increase in damage (+0.28/month). Similarly, kidney function declined more slowly in the IVIG group, with an average monthly drop in eGFR of just -0.4 ml/min, compared to -1.1 ml/min in the no-IVIG group.
Although patient and graft survival were similar at 12 months, IVIG-treated patients also showed a reduction in B-cell related gene activity within the graft, suggesting a broader immunomodulatory effect.
“IVIG appeared to stabilise both graft function and histology in patients with chronic active AMR,” the authors concluded, offering cautious optimism in an area where treatment options remain limited.
Given the lack of proven therapies for chronic AMR, this study adds important evidence that could influence future guidelines and treatment strategies. Further research in larger cohorts and over longer periods is needed to confirm whether IVIG can meaningfully improve long-term survival of transplanted kidneys.
Reference
Mulley WR et al. A randomized controlled trial of intravenous immunoglobulin vs standard of care for the treatment of chronic active antibody-mediated rejection in kidney transplant recipients. Kidney Int. 2025;DOI: 10.1016/j.kint.2025.04.023.
