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Titolo:
Hypogammaglobulinemia in lung transplant recipients
Autore:
Goldfarb, NS; Avery, RK; Goormastic, M; Mehta, AC; Schilz, R; Smedira, N; Pien, L; Haug, MT; Gordon, SH; Hague, LK; Dresing, JM; Evans-Walker, T; Maurer, JR;
Indirizzi:
Cleveland Clin Fdn, Dept Infect Dis, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 ct Dis, Cleveland, OH 44195 USA Cleveland Clin Fdn, Transplant Ctr, Cleveland, OH 44195 USA Cleveland ClinFdn Cleveland OH USA 44195 nt Ctr, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Pulm Med, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 lm Med, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Allergy Immunol, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 mmunol, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Thorac Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 c Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Pharm, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 Pharm, Cleveland, OH 44195 USA
Titolo Testata:
TRANSPLANTATION
fascicolo: 2, volume: 71, anno: 2001,
pagine: 242 - 246
SICI:
0041-1337(20010127)71:2<242:HILTR>2.0.ZU;2-F
Fonte:
ISI
Lingua:
ENG
Soggetto:
BRONCHIOLITIS OBLITERANS SYNDROME; PULMONARY TRANSPLANTATION; CYTOMEGALOVIRUS-INFECTION; PROPHYLACTIC GANCICLOVIR; PREVENT CYTOMEGALOVIRUS; RISK-FACTORS; DISEASE; IMMUNOGLOBULIN; REJECTION; SURVIVAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
27
Recensione:
Indirizzi per estratti:
Indirizzo: Avery, RK Cleveland Clin Fdn, Dept Infect Dis, 9500 Euclid Ave,Desk S-32, Cleveland,OH 44195 USA Cleveland Clin Fdn 9500 Euclid Ave,Desk S-32 Cleveland OH USA 44195
Citazione:
N.S. Goldfarb et al., "Hypogammaglobulinemia in lung transplant recipients", TRANSPLANT, 71(2), 2001, pp. 242-246

Abstract

Background. Infectious complications continue to represent a significant source of morbidity and mortality in lung transplant recipients. Identifyingspecific, remediable immune defects is of potential value. After one lung transplant patient with recurrent infections was noted to be severely hypogammaglobulinemic, a screening program for humoral immune defects was instituted. The object ic es were to define the prevalence of hypogammaglobulinemia in lung transplant recipients, assess levels of antibody to specific pathogens, and correlate infectious disease outcomes and survival with immunoglobulin levels. Methods. All lung transplant recipients followed at a single center between October 1996 and June 1999 underwent a posttransplant humoral immune status survey as part of routine posttransplant follow-up. This sun ey consistsof total immunoglobulin levels (IgG, IgM, IgA), IgG subclasses (IgG1-4), and antibody titers to Pneumococcus, diphtheria, and tetanus. Since February1997, this survey has been incorporated into the pretransplant evaluation as well. Humoral survey results for October 1996 through July 1999 were recorded, and clinical information on major infectious disease outcomes was obtained from chart reviews, discharge summaries, the Cleveland Clinic Unified Transplant Database, and review of all microbiological studies and pathology results for each patient. Results. Of 67 patients with humoral immune surveys drawn posttransplant, 47 (70%) had IgG levels less than 600 mg/dl (normal 717-1410 mg/dl), of which 25 (37%) had IgG levels less than 400 mg/dl ("lowest IgG group") and 22 (33%) had IgG levels between 400 and 600 mg/dl ("moderately low IgG group"). A total of 20 patients (30%) had IgG levels of more than 600 mg/dl ("normal IgG group"). Infections that were significantly more common in the lowest IgG group, and more common in the moderately low IgG group than the normal IgG group, included: number of pneumonias (P=0.0006), bacteremias (P=0.02), total bacterial infections (P=0.002), tissue-invasive cytomegalovirus (P=0.01), invasive aspergillosis (P=0.001), total fungal infections (P=0.001), and total infections (P=0.006). Median hospital days per posttransplant year was significantly different in the three groups (11.0 vs. 7.4 vs. 2.8 days, P=0.0003. ) Invasive aspergillosis occurred in 44% of the lowest IgG group, 9% of the moderately low IgG group, and 0% of the normal IgG group (P<0.001). Survival was poorest in the lowest IgG group and intermediate in the moderately low IgG group. IgG subclass deficiencies occurred in a varietyof patterns. Hypogammaglobulinemic patients lacked protective responses toPneumococcus in 14/47 (30%), diphtheria in 15%, and tetanus in 199. In a group of 48 patients screened pretransplant, 90% had normal immunoglobulin levels. Conclusions. Hypogammaglobulinemia in lung transplant recipients is more common than has been previously recognized. An IgG level of less than 400 mg/dl identifies a group at extremely high risk of bacterial and fungal infections, tissue-invasive cytomegalovirus, and poorer survival. Immunoglobulinmonitoring may offer an opportunity for intensive surveillance, tapering of immunosuppression, and preemptive therapy for infection.

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Documento generato il 05/07/20 alle ore 09:38:50